IMPROVING LIVESEND OF YEAR 3 EVALUATION REPORT December 2019

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CONTENTS

Executive Summary...........................................................................................................3

Evaluation Activities...........................................................................................................6

Progress in Implementation...............................................................................................7

Service Developments.....................................................................................................13

Service User Feedback.....................................................................................................17

Impact on Service Users..................................................................................................21

Key Learning....................................................................................................................27

Key Priorities for Year 4 ...................................................................................................27

Conclusions......................................................................................................................28

Appendix 1: Summary of Project Targets.........................................................................29

Appendix 2: Service User Case Studies............................................................................31

Appendix 3: WHO5 Wellbeing Index Scores.....................................................................33

Appendix 4: Summary of Exit Questionnaire Scores........................................................34

Appendix 5: Summary of Outcome Ladder Data..............................................................35

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EXECUTIVE SUMMARY

In October 2016 Improving Lives was awarded a grant from the Big Lottery (now National Lottery Community Fund) to deliver a programme of progression-oriented support to vulnerable people with enduring mental health issues. The project has now completed its third year.

Client engagement

Over the last year, 38 new referrals were received, primarily from Social Care and mental health services. There has been a growing number of inappropriate referrals, some referrers mistaking the service for general befriending support or for a mechanism to replace Social Care support. Clients are presenting with similar primary issues to previous years but with increasingly complex support needs as a result of multiple disadvantage.Over the course of the year 63 individuals actively engaged with the service. The duration of support received has varied according to client needs, but is consistent with expectations.

One to one support

The service continues to provide whole-life support. Over the last year this has included:

Service users are evidently overwhelmed when trying to tackle these issues alone, and a considerable amount of advocacy support with partner organisations has been required. It is apparent that the majority of services users are not aware of their basic rights and entitlements and would not be able to advocate for themselves if they were. The support of Improving Lives workers is therefore crucial in helping service users to meet their basic needs. Particular challenges were noted in relation to benefits and housing issues. Service users live in fear of their benefits being withdrawn. Landlords (both social and private sector) failing to conduct repairs or tackle anti-social behaviour has had a profoundly negative impact on service users’ wellbeing. It appears that statutory sector services are not fully aware of the particularly significant impact that their standard procedures have on people with long-term mental health issues. Service users rate Improving Lives’ support very highly, 67% of exit questionnaire respondents rating the service as ‘excellent’, and 28% as ‘good’. There was universal agreement that support workers listen to them and understand their needs. Service users noted that the staff offers a combination of non-judgemental understanding, very

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Emotional support and encouragement

Support to resolve daily-life problems, including referral to

specialist advice

Help to engage with basic health services

including accompanying to

appointments

Addressing financial difficulties and debts

Applying for various benefits and

appealing decisions

Tackling housing issues and finding

suitable accomodation

comprehensive knowledge of opportunities and rights, plus the resourcefulness and determination to take action.

Groups and trips

Over the course of the year 50 different service users attended the various group activities and trips provided by the project. This has included the introduction of the new Craft Group, which is a new initiative run by a service user. The group has been well received and has provided a considerable boost in confidence to the individual who runs in. Service users report that group activities are a key component of their recovery journey. They value the camaraderie and mutual support created through the groups, and the social networks generated have started to cross into the community.

Progression activities

Service users have been supported to engage with a range of community activities and training opportunities. They have also been encouraging to engage with volunteering (five service users volunteered with external organisations, and seven volunteered with Improving Lives itself). However, service users expressed concern at the idea of volunteering as a means to boosting employability, feeling that this is exploitative. The requirements of various Job Centre Plus schemes was noted as particularly distressing and destabilising for people with long term mental health conditions.

Volunteers

Non-service user volunteer numbers have dwindled and the project has struggled to provide the befriending service this year. The team are aware of the need to invest more resources into identifying the right types of people to volunteer with the service. However, this is difficult without a dedicated volunteer coordinator. Attempts to find funding for such a post were unsuccessful this year.

Partnership working

Opportunities for direct collaboration with the other services have been limited, with a continued reduction in the capacity of partner services, and a tightening of eligibility criteria across both the statutory and voluntary sectors. The team note particular challenges in engaging support from mental health services and are concerned about a growing gap in advocacy support. The team did, however, run a very successful event for Mental Health Awareness Week, engaging 17 external organisations at a drop-in information event which was attended by 75 service users. There is some evidence that some service users have followed up on information received on the day.The team are activity following developments regarding the Integrated Care System and Social Prescribing although it may be some time before changes take effect in practice. The team attend a number of strategic meetings including CAPITA (providing feedback about benefits issues) and the Patient and Public Engagement Committee for Strategic Commissioning.

Impacts on service users

The project has generated a wide range of impacts over the last year, in line with its planed outcome targets and beyond, summarised in the diagram below.

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Diagram 1: Summary of key impacts as reported by service uses

In terms of engagement with services, service users stressed that, as a result of Improving Lives, they are receiving better support from healthcare services, and feel more confident to request the help they need. Around half of all service users report that they feel more part of, and are more involved in, the local community.In terms of their housing, 58% of service users report an improvement in their housing. Feeling safer in their home was reported to be a key driver of good mental health and wellbeing, with 79% of service users reporting a positive impact. Only 41% of service users showed a significant increase in their WHO wellbeing index scores. However, the data suggests that it take time to generate significant changes in wellbeing according to the parameters embedded in this measure. Eleven service users engaged in some form of training, two taking part in training that would strengthen their employability. Two service users have reengaged in full time education and one has returned to employment.

Development priorities for year 4

On the basis of the successes over year 3, the following key developmental priorities are proposed:

1. Continue to develop and expand the group activity offer 2. Strengthen the befriender programme 3. Seek funding for a Volunteer Coordinator 4. Seek ways to raise awareness of the challenges that service users face through

strategic partnership meetings5. Introduce and embed the new client information system (Lamplight)

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Reduced social isolation

69% report reduced loneliness & isolation50% report they are more involved in community life 74% report improved emotional wellbeing

Improved physical and

mental

75% report managing mental or physical health better75% report reduced stress, anxiety or depression63% report greater access to specialist support services 61%* attend health appointments more regularly

Increased independence

88%* ‘know more about other support services’72%* 'feel more confident to contact services when needed'75%* are ‘better able to manage day to day life’ 77%* are ‘more confident to deal with problems’

Increased financial security

10 service users assisted to address £55,000 of debt8 service users had a debt plan put in place18 service users obtained benefits to an annual value of £104,200 p.a.

EVALUATION ACTIVITIES

In October 2016 Improving Lives was awarded a grant from the Big Lottery (now National Lottery Community Fund) Reaching Communities programme to deliver a programme of progression-oriented support to vulnerable people with enduring mental health issues. An independent evaluation was commissioned to run alongside project delivery over the life of the project. The project has now completed its third year.Evaluation activities over year 3 included the following activities:

Mid-year and end of year meetings with the CEO (and new interim CEO) Analysis of all client data A focus group engaging 10 service users Individual telephone interviews with the service user volunteer who runs the craft

group, and the volunteer who runs the art group Analysis of all service user evaluation questionnaires including 49 WHO 5

wellbeing surveys, 42 outcomes ladders and 18 exit questionnaires A partner survey to those organisations who attended the Mental Health Week

open event (with 7 responses). Findings from the evaluation, including recommendations for the coming year, are summarised in this report.

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PROGRESS IN IMPLEMENTATION

General overviewOver the last year the project has continued in a similar vein to year 2, using the same basic methodology and approach. The addition of a new worker to the team has meant that a waiting list is no longer needed.

ReferralsOver the year:

38 clients were referred to the service. Referrals continue to come primarily from Social Care and mental health

services, with a small number of referrals from other community organisations such as Women’s Aid (for people leaving secondary care mental health services).

However, the project is receiving a growing number of inappropriate referrals. Some referrers appear to think that the service offers general befriending support. Others seem to be treating Improving Lives as a mechanism to replace Social Care support.

Client engagement The staff team had some form of contact with 71 clients over the course of the

year. 8 did not respond to initial contact or refused help. A total of 63 individuals engaged with the service.

The type of contact was recorded for 45 clients who engaged in the service: 7% were provided with ‘intensive support’, 71% received ‘general support’, and 22% were provided support to meet immediate or crisis needs only.A total of 32 active cases were closed over the year (plus the 8 that did not engage). A total of 28% of those cases were closed within 6 months, 38% in 6 to 12 months, 19% in 12 to 18 months, and 16% in over 18 months. This is consistent with expectations and reflects the diversity of service users’ needs.

Client demographics and needs 70% of all clients this year were female and 30% male. In terms of ethnicity, 65% were White British and 7% White European; 15% were

Black British, Black Caribbean or Black African; 3% were Asian British; and 7% were Dual Heritage.

Clients are presenting with similar primary issues to previous years. In addition to their diagnosed mental health conditions, clients present with significant issues in relation to anxiety, depression and suicidal thoughts; long term physical health conditions including chronic pain; social isolation; benefits issues and debt; housing and tenancy issues; domestic violence and abuse; drug and alcohol misuse or gambling addiction; issues with completing paperwork and correspondence; and challenges accessing appointments.

Service users continue to be referred with increasingly complex needs.

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Some service users continue to require support over a prolonged period, particularly as a result of multiple disadvantage. The staff team report that there is nothing and no one else to support them and therefore the team are loath to close their cases.

Diagram 1: Examples of clients’ complex needs at point of referral (as recorded in client database)

One-to-one support The service continues to provide whole-life support. Examples of activities are summarised in the diagram below. Support to resolve daily-life problems has been a central component of the service. As noted, many service users have complex and ongoing challenges alongside their mental health issues, including carer responsibilities for vulnerable family members. As a result they can become easily overwhelmed with the problems they face in their daily lives. Obtaining basic information to solve their own problems was also a challenge for many, particularly given that some service users do not have access to the internet, such that simply Googling the answer to a question is not an option available to them. Accompanying service users to appointments with health care providers continues to be key. Service users stressed that even people who present as confident and assertive can feel very frightened and intimidated when faced with people they don’t know, and this includes during one-to-one appointments with medical services. Service users gave a clear message that they would simply not attend medical appointments without being accompanied by a staff member.Service users have been helped to apply for a range of benefits. They noted how overwhelming applying for benefits was, reporting that they would not have been able to complete the process without support. As noted by one service user, “Just the first page would overwhelm me.” Further, many service users were not aware that they were entitled to certain benefits, something that other supporting agencies, including Social Care, had not recognised. It was alarming to note how quickly service users found themselves in financial difficulty resulting in significant levels of debt. The team note that fewer clients have requested support with debt this year than in previous years. In some instances this

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Client is currently self-harming and experiencing suicidal thoughts. Has

been discharged from the crisis team with no other support in place.

Requires support to access services and manage appointments.

Client has difficulty managing money and has no bank accounts. Needs support to finish applying for PIP.

Needs to register with a GP and needs help keeping track of appointments.

Has difficulty seeking help and support. Previous suicide attempt.

Client is isolated and lives alone. Cares for mother. Significant physical health issues and a history of Schizophrenia.

Problems with debt and gambling. Wants to make a change but requires support.

Client struggles with mental health due to history of abuse and trauma. Feels

vulnerable when in the community due to flashbacks. Since stopping taking

drugs client has found herself lacking positive social contact. Ongoing tenancy issues but does not want to move. Poor

physical health.

appears to be because clients are less willing to face their debt issues. The team note that it takes time for service users to develop sufficient confidence and trust to open up on such a difficult subject. Many service users were faced with appalling issues in relation to their homes including harassment from neighbours and negligent landlords requiring advocacy support from the team. The team have sought to provide additional opportunities to support the emotional health and wellbeing of service users this year. This has included providing one-to-one reiki therapy sessions (funded through an Awards For All grant), with in the region of 30 service users taking up this support. This activity was very well received, and inspired interest in other relaxation therapies. The team continue to see clients who are not able to afford the social care package which they require. The team talk to service users about the importance of this care and seek to help them to access the care they need in other ways. This includes sourcing small scale grants or household items and helping them to reduce the cost of living e.g. by switching utility suppliers and applying for reductions in Council Tax. Overall, it is apparent that the majority of services users are not aware of their basic rights and entitlements and would not be able to advocate for themselves if they were. The support of Improving Lives workers is therefore crucial in helping service users to meet their basic needs.

Signposting and referral

Signposting and referral to broader services continues in a similar vein to previous years. Over the last year this has included referrals to counselling, occupational therapists, the Law Centre and Welfare Rights, plus one safeguarding referral. However, the ongoing closure or reduction in external services make referrals challenging. As noted by one service user: “The only issue I ever had were related to lack of other resources and services being cut so there were difficulties referring/signposting me to support outside of (Improving Lives’) parameters.”

Befrienders

Four service users have received the support of a befriender. Service users at the focus group were not aware that having a befriender was

possible but very much welcomed the idea. This year the project has struggled to provide this service, due to a limited

number of volunteers coming forward to offer this type of support. While staff resources are stretched, befrienders can take on many types of essential support that are time consuming for staff members and that do not need specialist expertise. The staff team are very aware of the crucial role of befrienders in enabling service user progression and they are keen to see this area of the project strengthening in the coming year. Recommendation 1. The staff team should reflect on ways to strengthen and expand befriending to support the sustainability of the service and the most effective use of staff time. Recommendation 2. The staff team may wish to contact sister services that have been successful in engaging and sustaining volunteer befrienders for clients with complex

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support needs (such as the Beyond Diagnosis Project at Self Help UK) in order to learn from their experience.

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Diagram 2: Examples of support provided by the Improving Lives Support Workers

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Talking through worries and concerns, offering encouragement and support to try new things

Emotional support

Helping service users to register for a GP or dentistHelping service users to have their needs assessments updated or prescription medication reviewed

Promoting engagement in statutory services

Attending work and hospital appointmentsAdvocating for clients with Welfare Rights ServiceSupport to raise concerns about a CPN and to hold landlords to account with maintenance issuesHelp to address issues with nuisance neighbours

Advocacy support

Setting up bill payment reminders on a mobile phone and setting up bill payment plansAccompanying clients to the bank to resolve issues with overdraft chargesDiscussing money worries and debt, putting in place a debt planApplying for PIP and Severe Disablement Allowance

Benefit and debt issues

Applying for grants, a blue badge, and to the Big Difference FundApplying for a reduction or exemption from council taxSwitching utility or broadband suppliers

Cost of living issues

Referring clients to Social Care for a support packageReferring clients to local foodbanks, Shareware for clothing, and The Arches

Meeting basic living needs and promoting independence

Helping clients to explore their housing options, register for social housing schemes and to search online housing portals.Liaising with landlords to get essential repairs booked and completed (e.g. repairing or replacing security lights, intercoms and door locks, appliances and boilers, and household electrics)Organising installation of safety equipment (e.g. smoke detectors and insulation)Obtaining household items such as a washing machine, a mattress, bedding, and baby furniture

Housing and home safety issues

Accompanying clients to appointments with mental health services and at the hospitalRefering clients to the Tenancy Support Service and Healthy Housing ServiceReferring clients to mental health services, DVA support services, Nottingham Law Centre, Powher (advocacy service) Victim Care, Harmless (self harm), the Together Project (suicide prevention), Ardent Care (hoarding) and to occupational therapy.

Accessing specialist advice and support

Helping clients to access community projects like Nature in Mind and the Women's CentreHelping clients to access local courses in sewing, cooking, photography and reikiHelping clients to engage with community facilities such as a local gym and art exhibitions

Accessing community services and activities

Groups and tripsThere has been a great deal of interest in groups this year and attendance has been reasonably steady. Over the course of the year 50 different service users attended the various group activities and trips1. This included:

21 people attended the pool group 22 people attended the arts group 4 clients attended the quiet group 31 people attended the various trips to community places

A considerable amount of effort has been put into planning, and raising specific funding for group trips to places of interest around the county. This included a narrow boat cruise on the River Trent plus trips to Wollaton Park, Highfields Park and Newstead Abbey, Nottingham Arts Exchange and Stonebridge City Farm. Groups also went bowling, to the Christmas panto, and to play adventure golf. Staff observed that service users are more comfortable with each other and are making friends. The social networks generated in the groups have started to cross into the community. Service users report that if they see other people from the service out on the street/in town they will stop and have a chat. Two service users even got engaged!The team have recently received an influx of referrals of female clients whose primary barrier is social isolation. Group activities have been particularly useful for these individuals once they gained the courage to attend.

The new service-user led craft group

A new craft group has been established this year, run by a service user volunteer. She is responsible for organising the activities and leading the sessions. Whilst she feels supported by the Improving Lives staff member who attends the group, she is very much in charge of the activity. The group has upcycled Christmas cards and picture frames, using old materials to keep costs down. She also asked participants to bring in their own ideas or projects. The group has been well received with six service users attending to date. The volunteer has observed participants expressing pride in their work, helping them to overcome negative self-perceptions. The activity has the potential to be a launch pad for progression activity. The volunteer actively encourages participants to continue the activities at home, including looking at videos online to learn new skills. She noted; “Lots of people had bad experiences at school and were told they were no good at art. I encourage people to do this at home instead of watching TV, to sit at the table, put the radio on with classic FM or some calming music, and do some crafts. Art can be very therapeutic. When you feel down, just get some paper and a pen and doodle. At the end of an hour you’ll be surprised at what you’ve drawn.”

The group has had a positive impact on the volunteer herself, reporting that she feels more confident, and that encouragement from the staff team, and her experience of running the group, has inspired her to go back to college to do an Access to Education

1 It should be noted that there are some challenges in determining the exact numbers of service users attending groups, as their names are written differently on the session registers, (e.g. sometimes in full, sometimes initials, sometimes nicknames). The team are moving to a new client management information system (Lamplight) which should ensure consistency in the future.

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course. She said, “Improving Lives has helped me so much over the years. I really wanted to give something back. I’ve really gotten a lot out of it. I didn’t think I’d be able to do it!”

Progression into community activitiesIn addition to the group trips, individual service users continue to be referred to a wide range of activities and organisations in the community including community gardens and children’s nurseries, plus other local voluntary sector services such as Open Doors, Nature in Mind, and the Allotment Project. Activities have also been sourced to meet individuals’ interests, e.g. one service user has started to do tai chi and another has been actively encouraged to do photography.

Progression into volunteering and trainingThe team have continued to refer service users into training courses. The Recovery College, which had engaged a number of service users in previous years, changed its eligibility criteria. As a result the team have sought out a range of alternative opportunities, such as courses delivered by WEA and the Women’s Centre. This has included stained glass window making, sewing, cooking, and IT. The team have also arranged some courses directly, e.g. a reiki taster course and a mindfulness course (attended by 9 service users), plus a performing arts course with Non Such Theatre (attended by 11 service users). This year five service users have progressed into volunteering externally, with seven service users volunteering in some form with Improving Lives itself.

External challenges The project continues to struggle with a number of externally driven challenges which have a profound impact upon its ability to conduct its work. Numerous examples were given of how issues with benefits have caused significant setbacks for service users. The staff team have found outcomes of PIP assessments to be highly unpredictable. They have been involved in several PIP appeals, all of which have been upheld, suggesting that the team’s understanding of service users’ entitlements are accurate. However, they note that service users live in fear that their benefits, which they rely on to survive, will be withdrawn, with a profound impact on their recovery. This is compounded by the fact that they must continually reapply for their benefits resulting in repeated and prolong stress. As noted by one staff member, “The fear, the waiting period is months, living in that awful state.” Feedback from service users also highlighted just how critical their home environment is to their wellbeing. However, this does not appear to be recognised by social housing providers or by private landlords, and significant negligence in relation to basic home safety and repairs has been observed. As noted by one service user, “No matter how many times I would ring them up (the social housing landlord) they didn’t get the repairs done. It took a toll on my health. I deteriorated.”

Recommendation 3. The team should reflect on how they could raise awareness amongst key statutory agencies about the impact of their behaviour on people with chronic mental health problems. This is particularly noted in relation to DWP requiring repeated reassessment of benefits, and the failure of housing agencies to make repairs and tackle anti-social behaviour.

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* All names have been changed.

SERVICE DEVELOPMENTS

Volunteers The number of volunteers has fallen over the course of the year, to 4. Five new

volunteers completed induction training, however only 1 progressed into volunteering, (the others entered employment or were no longer able to volunteer).

Many volunteers who approach the service are university students looking for 30 hr placements only, and for a limited period of time that fits with their studies.

Few volunteers want to offer befriending support, which can be a longer term commitment.

The staff team are aware of the need to invest more time and resources into identifying the right types of people to volunteer with the service. However, this is difficult without a dedicated volunteer coordinator. In collaboration with another local charity, Improving Lives bid for funding for a Volunteer Coordinator, however, this was unsuccessful. Recommendation 4. Finding resources to employ a Volunteer Coordinator will be essential to increasing volunteer capacity and creating opportunities for progression beyond staff-led support. The project has been successful in translating the interests of individual service users and volunteers into volunteer-led activities. This includes the new craft group and the existing art group, both of which were individual initiatives. This not only brings a new strand of activity to the service, with a benefit to service users, it also has a positive impact on the volunteers themselves. Recommendation 5. The team should reflect on ways to expand opportunities for individual initiative volunteer-led projects. This could be combined with attempts to expand befriending. For example, people with a particular interest or hobby could accompany individual service users to community events or activities related to their interest or hobby.

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Case study: The impact of continual reassessment of benefits

David* had made great progress. He was taking part in lots of social activities and was feeling very positive about life. However, out of the blue, he received a letter saying that his PIP was going to be reassessed. He phoned Improving Lives in a panic. He was very upset and felt that he couldn’t cope at the thought of his benefits being questioned. His mental health took a sharp downturn as a result.

Case Study: The Art Group as a Volunteer-Inspired Initiative

The Art Group began two years ago and is run by a volunteer, Filip*. Filip had been supporting the service as a befriender. His service user was interested in doing more art. Filip said, “I am not a professional artist but I have an appreciation for art. Together, I encouraged him to do art, and we went to galleries. It occurred to me that others might be interested too. I gave it a go and it worked!” The group meets on a monthly basis, each session having its own theme. Around 10 service users took part in the first year. Since then the group has been split into two activities, one as a more general drop-in and one allowing for more advanced interest in art. This last year the group started to visit exhibitions in local galleries which participants

* All names have been changed.

Partnership working

Mental Health Awareness Week Multi-Agency Open Day

The team ran an open day in October 2019, engaging 17 different services who provided information stalls and activities.

The event went very well with in the region of 75 service users attending. Service users showed a great interest and actively engaged with the various

services present.

Staff holders from partner organisations were asked to complete a survey about the event. Feedback was very positive, with 43% of respondents rating the event as excellent and 57% as good. They report that the event was well organised, that its purpose was clear and that attendees engaged well with them. A total of 72% of respondents agreed that they interacted with a good number of attendees at the event, and 86% agreed that attendees actively engaged in conversation with them, expressed interest in the services they offer, and took away the information and resources they provided. Partners reported a range of impacts from the event on their own organisations, including meeting new potential service users and promoting their service, sharing information, and networking with other organisations. If the event were run again, 71% of respondents stated that they would definitely attend, 14% stated that they would attend, and 14% stated that they might attend. Partners said:

“From an interactive point of view the event was spot on, thank you.”

“I have noticed that we have an upturn in the number of drop-in sessions with people who have identified mental health as a barrier to their own volunteering since the event. I have not monitored whether attendees at the event have subsequently come into the Volunteer Centre, but as the numbers of people with "mental health" barriers have increased, it is very likely that at least some of them have come via your event.”

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Case Study: The Art Group as a Volunteer-Inspired Initiative

The Art Group began two years ago and is run by a volunteer, Filip*. Filip had been supporting the service as a befriender. His service user was interested in doing more art. Filip said, “I am not a professional artist but I have an appreciation for art. Together, I encouraged him to do art, and we went to galleries. It occurred to me that others might be interested too. I gave it a go and it worked!” The group meets on a monthly basis, each session having its own theme. Around 10 service users took part in the first year. Since then the group has been split into two activities, one as a more general drop-in and one allowing for more advanced interest in art. This last year the group started to visit exhibitions in local galleries which participants

Open day was attended by:

Stonebridge City FarmNature in Mind

Windmill Gardens Allotment Project

Wellness in Mind

Do RunningRed Cross Connecting

CommunitiesHealth Watch

NCVS

Notts Cybercrime TeamNotts Romance Fraud Team

Victim CareNational Justice Museum

WEA

There is some evidence that service users have followed up on information received on the day. Since the event, 29% of partner survey respondents stated that they have received contact from participants whom they expect to start engaging with their service soon, whilst 14% report that participants have contacted them for general information. This was particularly noted by an organisation promoting volunteering opportunities in the local community.

Diagram 3: Percentage of Open Event partners that agreed or strongly agreed with key statements about the benefits of attending

Challenges in collaboration

Opportunities for direct collaboration with the other services have been limited this last year. The staff team report a continuation in the collapse in capacity of partner services, particularly in statutory sector services, with a tightening of eligibility criteria across both the statutory and voluntary sectors. Staff turnover in external services is high and staff burnout is commonplace. At the same time, the team struggle to find out what has changed and communication with key services seems to have been a challenge. Service users are also keenly aware of the gaps in broader service provision. As noted by two service users, ”Services are so disjointed. I’ve had to set up my own support, like paying for counselling,” and “Improving Lives hoovers up people who are falling through the cracks.“

Changes towards an Integrated Care System (ICS) are still being explored, however, the team have been given contradictory information about the future of service provision. Some report that it may be several years before funding for integrated service pathways is confirmed. Under ICS practitioners will be expected to work closely with voluntary and community sector providers.

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71% It gave us an opportunity to meet new potential service users 

57% It gave us an opportunity to promote what we do with potential service users

86%It gave us an opportunity to share useful information and resources with individuals 

100%

It gave us an opportunity to network with other organisations and service providers 

57% We picked up useful information about other services in the area

43% It helped us to strengthen our working relationship with Improving Lives

Open day was attended by:

Stonebridge City FarmNature in Mind

Windmill Gardens Allotment Project

Wellness in Mind

Do RunningRed Cross Connecting

CommunitiesHealth Watch

NCVS

Notts Cybercrime TeamNotts Romance Fraud Team

Victim CareNational Justice Museum

WEA

Social prescribing has not yet begun in earnest, although it is understood that Link Workers are due to be in post in January. However, Improving Lives is receiving mixed messages about how social prescribing activities in the community will be funded. It appears that only the signposting function will be funded through the programme, presuming that voluntary sector services will continue to exist independently and indefinitely.The team note particular challenges in engaging support from mental health services, in which staff morale seems to be at an all-time low after a very poor Care Quality Commission audit of the Mental Health Trust. The team have sought to address these challenges with the appropriate authorities, meeting with both the Executive Medical Director of the Healthcare Trust and the Executive Director of Mental Health Services for the Healthcare Trust over the course of the year. While Improving Lives’ concerns were recognised in these meetings, it does not appear that this has generated any noticeable change. The team report a growing gap in advocacy support for this client group. POhWER, the service commissioned to deliver advocacy services in Nottingham City, only supports individuals in hospitals and residential care settings. Clients need help with equipment and housing repairs, plus help in making complaints. Without external advocacy support, Improving Lives staff are picking up the responsibility to support clients with these issues when they are eligible for mainstream services. Others are left without a service and this is a significant gap in provision.

Influence and information sharingThe team attend a number of strategic meetings, with a view to giving feedback and having influence, including CAPITA (providing feedback about benefits issues) and the Patient and Public Engagement Committee for Strategic Commissioning (PPEC), which sits alongside the Integrated Care System, and the Safeguarding Leads Meeting.The PPEC presents a significant opportunity for influence, and it would be possible for Improving Lives to make a presentation of key learning at this meeting. It was noted, however, that the presentation would need to be framed around an ‘ask’ of those present. Recommendation 6. It is recommended that the staff team make a formal presentation to the PPEC. This could be framed around raising awareness of the barriers that people enduring mental health issues face when seeking to engage with key services, in particular housing and welfare benefits. The staff team will need to give serious consideration to what they think members of the PPEC do not fully understand and need to hear. The presentation would also need to include proposals as to how those services could become better sensitised to the needs of service users.

Co-production Co-production continues to be a core feature of Improving Lives’ methodology, and mechanisms for service user engagement have continued. Service users confirm that they are continually asked for their input and feel that their ideas and suggestions would be welcomed. As discussed above, a new group (the Craft Group) which started this last year, is led by a service user. Over the course of the year, seven service users have been involved in supporting Improving Lives in one form or another e.g. taking photos at a community event. The organisation engaged an experienced service user on the Board, however, this has not worked as well as hoped and the service user has now stepped down.

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Recommendation 7. The staff team may wish to consider alternative ways to create service user input to the Board, for example, the team could introduce a consultative group which meets on a quarterly basis with members of the Board to share and explore ideas for the strategic development of the organisation.

SERVICE USER FEEDBACK

Evaluation tools

Considerable effort has been put into using the project’s monitoring and evaluation tools over the last year. As a result:

Eighteen exit questionnaires were completed this year. A total of 49 initial sets of WHO5 wellbeing questionnaire scores were

captured this year. A total of 22 sets of repeat scores were available. In relation to the outcome ladders, some data was entered for 42 service users,

with two sets of scores recorded for 19 service users. This is a considerable improvement on year 2, although a small number of errors in data entry were noted2.

Recommendation 8. A refresher on how to use the outcomes ladder may be useful, reminding staff of the importance of entering a score for all topics.Recommendation 9. It may be useful for staff members to create their own prompt sheet, reminding them of the dates for evaluation tools to be reviewed with each of their service users. While staff members are putting in considerable effort to capture evaluation information, it appears that this is not being systematically reflected upon as a team. Rather, staff read the annual independent evaluation report and reflect on the learning individually. Recommendation 10.The CEO may wish to plan a specific meeting for the staff team to discuss the annual evaluation report and reflect on its findings together, in order to ensure learning is explored collectively as a team.

Service user perceptions of the service

Service users rate the support they receive very highly and express strong sentiments of gratitude for the support they have received.

In the exit questionnaires, 67% rate the service as excellent, and 28% as good. The broad range of support available through a whole-life approach was particularly noted. Service users noted that the support is entirely tailored to their individual needs. As noted by one focus group participant, “They cater for you individually. That’s marvellous.”

2 Some service user records had no score against one or two topics in the initial assessment, but scores were included in subsequent reviews. Particular gaps were noted in relation to ‘Taking part in community life’ and ‘Learning and employment’. In order to analyse the data, the review scores in these cases were removed as no comparison was possible without the initial scores.

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Service user perceptions of the staff team

Feedback for support workers was very positive. A total of 96% of service users ‘definitely agreed’ and 4% ‘agreed’ that their

support worker listens to them and did what they said they would do. All survey respondents definitely agreed that their support worker understood

their needs, while 89% ‘definitely agreed’ and 11% ‘agreed’ that their support worker ‘treated me like a person’.

Service users note that staff support offers a combination of non-judgemental understanding, very comprehensive knowledge of opportunities and rights, plus the resourcefulness and determination to take action. They stressed how extensive the knowledge of the staff team is, and a sense that they can contact the team about anything. The immediate recognition of their needs and entitlements, coupled with a commitment to action gives service users great confidence in the service and its staff team3. Service users noted the commitment of the staff team to keeping in touch and keeping them informed. For example, support workers will send them several text reminders for activities, including on the day. Service users also report a strong sense that their ideas are welcome and encouraged.Comments included:

“I have always felt like I have been listened to. My worker has always gone out on their way to find things out for me. I have always felt safe in their company.”

“He’s easy going. He seems to understand. He doesn’t judge. You feel like you’ve known him for a long time. He’s very knowledgeable, and he doesn’t forget (what’s happening in your life). “

“He doesn’t judge or look down on you. Very supportive and very intelligent.”

“It’s surprising to me how knowledgeable they are. Things that wouldn’t have occurred to me. They know the answer straight away.”

“Having someone to point us in the right direction. Any problem you can just ring up, and if they can’t help you they will point you in the direction of someone who can. You don’t need to struggle on your own.”

Service user perceptions of the groups

Service users report that group activities are a key component of their recovery journey.

While it can be intimidating to go to groups at first, they noted that everyone is very welcoming and that once you get there you feel more confident to stay.

They report that there is a strong sense of camaraderie, coupled with caring and nurturing support between members.

At the service user focus group there appeared to be genuine respect amongst participants. They helped one another to communicate their thoughts and really listened to each other without judgement. They noted that groups create an opportunity for

3 One service user contrasted this level of knowledge with another service she had been supported by which had not recognised the benefits she was entitled to despite supporting her for over two years.

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‘normal’ social interaction, conversation and ‘banter’, making them feel part of a community where others can relate to their experiences. Feedback from service users demonstrated how difficult some find it to organise social activities for themselves, and that this is unlikely to change even with progression-oriented support. For example, one service user had a stroke and now struggles to remember things, making it very difficult to make plans. He noted that without the Improving Lives groups he would not get out of his house. Others noted that the groups are even more important in winter time when it is even harder to motivate themselves to get out.

“I really like going to groups, everyone is so nice and friendly there. “As a group we can all relate to each other. We’re making the best of our situation together.”

“It’s like a family. Everyone is the same. We all have problems in different ways. But if you have a laugh and a joke it helps you get through the day.”

“It’s like a friendly club. It’s something to do socially. There’s a bit of banter. I look forward to going. It’s something to look forward to.”

“You can get stuck inside your own four walls, with no momentum. You say, ‘I’ll go out tomorrow’ and the bad weather makes it worse.”

Service user perceptions of the trips

Service users were very enthusiastic about the trips offered over the last year. They particularly appreciated having activities organised for them, one service user noting, “They find things for us to do. It takes the pressure off.” Some service users noted that they probably wouldn’t go and do these things alone. Having a few familiar faces with them makes them feel confident to go to new places. However, others stated that it had inspired them to go out to local parks on their own. Service users were very aware of the cost of providing the trips, and the limited resources available to run them. For example, they noted that they sometimes go to places but cannot take part in the paid attractions when they get there. This was not presented as a significant issue, but as a reminder that activities like these require financial support. “It was good. I’ve never been on a narrow boat before. It was a blinding day.”

“When I lost my family I lost my nerve to go out. But (since doing the trips) I’ve started going out to the Arboretum and Trent Bridge.”

Volunteering as a means to increasing employability

Service users expressed very considerable frustration about the idea of volunteering as a means to gaining employment. Several people felt that being required to volunteer was exploitative and disheartening rather than empowering. A great deal of anger was also expressed in relation to the Job Centre, regarding seemingly arbitrary rules about jobs that they were not allowed to, or were required to, apply for. It was evident that the distress generated by these requirements was extensive and overwhelming for people with long term mental health conditions, something that the DWP may not take into consideration when supporting these types of clients. Service users also noted how insecure many employment contracts are. It was clear that the fear of that insecurity was acutely debilitating for these clients.

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Recommendation 11.The team should reflect on how they might be able to raise awareness amongst DWP staff about the particular impact that job seeking requirements have on people with long term mental health conditions.

Changes to the service

Very few changes to the service were requested, service users highly valuing the support and activities currently on offer. Service users would welcome more trips to community venues but recognise that this requires additional funding. Transport to activities and groups was also recognised as a challenge for some. One service user suggested a drop-in group simply aimed at socialising. This type of activity might be suitable for a volunteer to run in a community venue such a local café. Recommendation 12.Explore introducing a social meet-up group in a local community venue run by a volunteer.Comments include:

Thank you, you’ve been fantastic and I can’t honestly thank you enough. Awesome the work you put in and help people. Thank you so much for getting us the cooker!

I’m extremely grateful for the help I’ve received from Improving Lives. Everything from financial help with PIP to trying new things on visits etc. Also my support worker has been a real help and has managed to get me to see the light on most things. So thank you very much.

I’ve had nothing but positive experiences with Improving Lives. The emotional and practical support I received was invaluable and has helped me to move on with my life.

We really appreciate all you do for us. Don’t know where we would be if it wasn’t for you.

“I’m really happy with Improving Lives. I only wish I’d learned about it earlier.”

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Case study: Frustrations with volunteering for employability and Job Centre Plus requirements

They gave examples of volunteering on 13-week work placements, only to be exited before the end of the 13 weeks so that they were not automatically entitled to a job placement. Another person volunteered for 2 years, on the understanding that it would eventually get her a job, with no sign of a job at the end of it. She said, “I completed my Health and Social Care level 1 and 2, and I was told to do voluntary work as it would help to get me a job. After 2 years of volunteering I felt I was being exploited. It never led to work.” One service user noted that he hadn’t been allowed to apply for a particular opportunity, which he was perfectly suited for, because he hadn’t been unemployed long enough. Another noted that he had to apply for jobs a very considerable distance from Nottingham or risk being sanctioned. This requirement had filled him with consuming anxiety and he had become preoccupied with worry.

IMPACT ON SERVICE USERS

Core outcomesImpacts on service users continue in a similar vein to previous years. Impacts are presented according to the four core outcomes below, followed by additional outcomes noted by service users and the staff team.

Outcome 1: Reduced social isolation for adults with long term mental health conditions

A wide range of impacts have been observed in relation to reducing social isolation4:

Service users particularly noted the positive impact of the service on reducing loneliness and isolation, and the resulting impact that has on improving their general sense of happiness, and on reducing anxiety and worry. Social anxiety was a very common theme noted by service users, including for those who present as reasonably confident and assertive. Service users noted the particular role that the Improving Lives groups play in overcoming social anxiety, promoting contact with others and reducing social isolation. They stressed that groups make them feel part of something.Service users report some increased confidence to engage with people in the outside world, as a result of building their confidence to communicate with others through groups.One service user noted that addressing her housing issues had helped her to have greater contact with family members, therefore strengthening her social networks and support considerably. Client comments include:

“I have begun engaging in groups and I am recovering my confidence.”

“I have been given a chance to get out and meet people and I feel a bit better about meeting people.”

I am with my family more as I have moved to Heanor in Derby thanks to (my support worker) and I see my family about 3-4 times a week.

4 Key: * Exit survey scores for impact statements ** Outcomes ladder scores

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50 clients attended group activities or trips

4 clients were supported by a befriender

69%* of clients report reduced loneliness & isolation

50%** of clients report they are more involved in community life

Outcome 2: Improved physical and mental health for those managing long term mental health conditions

The vast majority of service users report an improvement in their mental and physical health5:

In addition: 88% of service users report ‘feeling happier and better in themselves’ (exit survey

scores) 41% of service users showed a significant increase in their WHO wellbeing index

scores (see appendix for further details). However, the data suggests that it take time to generate significant changes in wellbeing according to the parameters embedded in this measure.

Service users stressed that they are, as a result of the support, receiving better support from healthcare services, and feel more confident to request the help they need.

Staff identified that five clients have had reduced contact with crisis services as a result of the support provided this year.

One service user noted a small but positive impact on her eating disorder, stating, “When I feel down I don’t eat. I could go five or six days and then realise that I’m feeling dizzy because I haven’t eaten in days.”

Table 1: Examples of key interventions to increase access to healthcare services

5 Key: * Exit survey scores for impact statements ** Outcomes ladder scores

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75%* report managing mental or physical health better

74%** report improved emotional wellbeing

75%* report reduced stress, anxiety or depression

63%** report greater access to specialist support services

61%* attend health appointments more regularly

Client comments include: “(My support worker) helped me with appointments at Highbury Hospital. I see a

clinical psychologist. She came with me on a couple of occasions. I wouldn’t have gone without someone to go with me. (With support) I feel less anxious and scared.”

“Such a difference! I was depressed, isolated and hopeless, and now I look forward to waking up and getting on with my life. I used to want to die - now I can’t wait to live.”

“I have a focus coming here. I tend to be quite depressed and worried. It’s really helpful to stop the spiral of worry and anxiety. (My support worker) reminds me that my issues can be dealt with. Regular contact with her keeps me on a level where I can begin to help myself.”

They’ve helped me tremendously. I was a nervous wreck before I came to Improving Lives.”

Outcome 3: Increased independence for those managing long term mental health conditions

Service users report an increase in their independence in a variety of ways6:

In addition: 67% of service users report feeling more empowered (outcomes ladder scores)

6 Key: * Exit survey scores for impact statements ** Outcomes ladder scores

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20 clients were assisted to access GPs

4 clients accessed a dentist

19 clients were assisted to access mental health services

11 clients were assisted to access hospital services

6 clients were referred to counselling support

1 client was referred for a Social Care package

3 clients were referred to an occupational therapist

88%* ‘know more about other support services’

72%* 'feel more confident to contact services when needed'

75%* are ‘better able to manage day to day life’

63%** report improved everyday living skills

77%* are ‘more confident to deal with problems’

73%* felt ‘more able to express themselves clearly to others’ (exit survey scores) 46% - 50% of service users are more involved in the local community (exit survey

scores and outcomes ladder scores) 44% of service users feel more a part of the local community (exit survey scores)Confidence, hope for the future and a greater motivation to tackle day to day problems were common themes in the feedback from service users. Service users report less of an impact on their ability to solve problems on their own. Many noted progress with this, but stressed that building these skills and abilities takes a long time, and may be out of reach for some due to their long term health conditions. Service users noted that when they feel depressed they forget what makes them feel better or how to help themselves. They report that coming to Improving Lives creates a rhythm to life that keeps their wellbeing “topped up”, preventing descent into a downward spiral, at the bottom of which all capacity for self-care is lost. Service users also reported that they now know how to contact broader services if they need help with daily living problems, and that they were receiving more support from other organisations. Client comments include:

“Here they helped me to put things in perspective. I learned a lot of resilience. Before I would just hide under my duvet.”

“I have issues with alcoholism and isolation but with the support I have received here I feel I am learning to cope with problems as they arise instead of putting things off. I am also trying to rebuild my confidence and plan to engage in other groups.”

“Nature in Mind, it’s been really fantastic to get out. It took a long time to build up the confidence, but now I’m learning new skills, improving my health and it’s given me a new focus. I’m beginning to enjoy things again.”

“Getting more confident to go out and growing in confidence generally. Hope for the future.”

Outcome 4: Increased financial security for those managing long term mental health conditions

Many service users report an improvement in their financial circumstances7:

In addition:

7 Note that the value of debt addressed was only recorded for 8 clients, therefore the total value of debt for those clients was extrapolated to estimate a value for all 10. The value of benefits awarded was only recorded for 16 clients, therefore the total value of benefits awarded was extrapolated to the full 18 clients.

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10 service users assisted to address £55,000 of debt

8 service users had a debt plan put in place

18 service users obtained benefits to an annual value of £104,200 p.a.

67% - 81% of service users report an improvement in their financial circumstances (outcomes ladder scores and exit survey scores respectively).

Benefits were discussed with 38 clients, and 30 clients were supported in relation to their benefits.

18 individuals were successful in being awarded benefits to the total value of £104,200 per year. In addition, back payment lump sums to the total value of £11,500 were also achieved.

4 individuals received grants to reduce their cost of living, to the total value of £1,870. 11 individuals were helped to reduce their bills, to a total value of £6,621.Feedback from service users stresses the absolutely critical role that their financial situation plays in their broader wellbeing and their ability to manage their mental health.

Client comments included: “Financially better off, home improvements, better understanding of situation.”

“Knowing I can pay the bills for the next two years makes you feel a bit better. I can start trying to get myself back to good health.”

“I don’t lose sleep over money now. I am glad I don’t have to worry about debt and benefits.”

“I had help with my council tax. I didn’t know I could apply to be exempt.”

Additional outcomes

Housing

58% of service users report an improvement in their housing (outcome ladder scores) and 100% report that their home is more habitable (exit survey scores)

79% of service users feel safer in their home (exit survey scores). Feeling safer in their home was reported to be a key driver of good mental health and wellbeing.

5 service users were helped to obtain more suitable housing. 4 service users were stopped from becoming homeless and 3 evictions were

prevented. 7 service users were helped to obtain items for their homes. The homes of 12 service users were made more habitable. Supporting service users to tackle housing issues and ensuring that their homes

are safe and comfortable has been key to strengthening independence, and emotional health and wellbeing.

Employment and training

11 service users engaged in some form of training, two taking part in training that would strengthen their employability.

Three service users were referred to the Opportunity and Change project which has an employment focus. As a result, one has accessed a peer mentoring course,

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another accessed work experience and developed a CV, and another is about to attend a job interview.

2 service users have reengaged in full time education. 1 service user has returned to employment. 38% of service users report an improvement in relation to learning and

employment.

The interactive nature of interventions and outcomes

Feedback from service users that demonstrate the interactive nature of the holistic range of support provided, generating a range of interlocking impacts. This is demonstrated in the service user comments below.

Diagram 4: Feedback from service users demonstrating the interactive nature of key impacts

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“My son has developed exponentially thanks to nursery. I have lost weight and improved my fitness which has improved my ability to manage my mental health which was also helped by the Recovery College. I am now living in a wonderful new home away from my toxic relationship and planning for my

future. I would not be in this position without (my support worker) and Improving Lives.”

“It’s made a huge difference to my life - I have somewhere to go when things are stressful at home. I have access to counselling that my worker helped me get. It may have even saved my life as I have felt safer having my PIP to buy

security items.”

“I was a big gambler. All my money went on gambling. I had £30,000 of debt. I was also caring for my mother at the time. I had to relate all of my issues to (my support worker). He went through all of my finances and sorted it all out,

sorted out my bankruptcy. He referred me to Gambling Anonymous. He sorted out my Disability Living Allowance. I couldn’t have filled it in, I really

would have struggled. He sorted out all the background documents so it was filled in right. He also referred me to counselling, to help me get everything

off my chest.”

“They supported me through a tough point in my life. When other organisations left me or failed to provide support the people here did not. My

key worker has been there every step from getting out of jail, to hostel, to finding and moving into a new home. I now have counselling sessions and I

have had a good start at rebuilding my life. I have not self-harmed or committed any crimes since getting out of prison six months ago. My health is

good and my mental state perfect. Without this service or funding for it I would easily reoffend or self-harm. Thank you for your help.”

KEY LEARNING

On the basis of these findings, the following points of key learning have been identified: Group activities and trips are proving particularly impactful this year, as a key

component of service users’ social capital, but also in promoting the confidence to engage more fully in community life. Group activities, supported by a staff member, can also be a mechanism to help service users to progress into volunteering.

The holistic nature of support results in multi-layered impacts for service users, each reinforcing the other.

Accompanying service users to appointments with medical and other services is essential to make services accessible and to empower individuals to manage their own health more effectively.

Addressing and resolving both financial and housing issues is of paramount importance to sustaining positive mental health. Seemingly minor changes in a vulnerable person’s housing or financial situation can be hugely traumatising and destabilising, with marked and lasting consequences for their mental health and wellbeing. Statutory services may not fully appreciate the extent to which these factors determine the wellbeing of vulnerable service users.

KEY PRIORITIES FOR YEAR 4

On the basis of the successes over year 3, the following key developmental priorities are proposed for year 4:

1. Continue to develop and expand the group activity offer – inviting service users to lead activities that related to their own personal interests wherever possible.

2. Strengthen the befriender programme – as a key component of the progression pathway and as a means to ensuring most efficient use of staffing resources.

3. Seek funding for a Volunteer Coordinator – this will be essential if Improving Lives wishes to identify and recruit additional volunteers with the appropriate skills, experience and personal circumstances to support the service.

4. Seek ways to raise awareness of the challenges that service users face through strategic partnership meetings – particularly in relation to housing and welfare benefits.

5. Introduce and embed the new client information system (Lamplight) – including training for staff in reporting and creating opportunities to periodically and collectively reflect on those reports.

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CONCLUSIONS

This has been a very successful year for the project, engaging a large number of service users and continuing to provide whole-life support. The emphasis on group activities and trips has been particularly well received this year, playing a significant role in reducing isolation and boosting wellbeing. Groups have also provided an opportunity for peer support, and for service users to share their own interests and expertise. The evaluation continues to find positive impacts on service users’ engagement with key support services, particularly in relation to healthcare, resulting in improved management of mental and physical health issues. Service users report some improvements in their ability to solve their own problems and manage their daily lives. However, it is evident that many will need long term support in this regard due to enduring health conditions and other complex challenges in their lives. Challenges in relation to partnership working continue with the closure of many services and continued uncertainty regarding key strategic developments in the sector. However, the team are doing their best to forge and strengthen relationships with other community-based services despite these constraints. It is evident that the staff team are overstretched. With the growing pressure on external services, the situation is unlikely to improve in the coming year. Finding ways to increase the number of volunteers and strengthen the befriending programme will be a priority in the year ahead.

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APPENDIX 1: SUMMARY OF PROJECT TARGETS

Outcome 1:

Target No. ppl Actual progress

Beneficiaries using the service will report feeling part of a community

45 /yr 46% of exit questionnaires respondents reported that they are more involved in their local community, and 44% that they feel more part of the community.

Beneficiaries of the service attend and participate in peer support groups and or accept a befriender

25 /yr 50 service users have participated in peer support groups or trips4 service users have received support from a befriender

Beneficiaries of the service will be trained volunteer befrienders

15 by end project

1 individual to date

Outcome 2:

Target No. ppl Actual progress

Beneficiaries of the service will attend their physical and mental health appointments

45/yr 61% of exit questionnaire respondents reported that they attend mental and physical health appointments more regularly 20 service users were assisted to access GPs and 4 clients were assisted to access a dentist.19 service users were assisted to access mental health services and 11 clients were assisted to access hospital services. 6 service users were referred to counselling support and 3 clients accessed an occupational therapist.1 service user was referred for a Social Care package.All service users are offered support to make and attend appointments

Beneficiaries will report an increase in their wellbeing

45/yr 74% of outcome star respondents reported an improvement in their emotional health and wellbeing69% of exit questionnaire respondents reported that they felt less lonely or isolated, and 88% that they felt happier in themselves.75% of exit questionnaire respondents reported that they are managing their mental or physical health better, and 75% that they feel less stressed, anxious or depressed41% of service users made a significant improvement in their WHO wellbeing index score.

Beneficiaries will report reduced contact with crisis mental health services

200 by end project

Staff recorded that 5 clients have had reduced contact with crisis services as a result of support this year. 1 safeguarding referral was made this year.

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Outcome 3:

Target No. ppl Actual progress

Beneficiaries of the service will report knowing how and when to access appropriate services

35 /yr 88% of exit questionnaire respondents reported that they ‘know more about other support services,’ and 82% that they feel ‘more confident to contact services when needed’

Beneficiaries report increased confidence in being able to express their view

40/yr 73% of exit questionnaire respondents reported that they felt ‘more able to express themselves clearly to other people’

Beneficiaries will report an improvement in everyday living skills

200 by end project

75% of exit questionnaire respondents reported that they were ‘better able to manage day to day life’, and 78% that they were ‘more confident to deal with problems’

Outcome 4: Target No. ppl Actual progress

Beneficiaries will be supported to access specialist debt services where necessary

45 /yr 8 service users had a debt plan put in place, and 10 service users were assisted to tackle debt.

Beneficiaries debts will be managed and/or decreased

40 /yr An estimated total debt of £55,000 was addressed8.

Beneficiaries will be supported to claim for appropriate benefits

225 by end project

18 service users were assisted to obtain additional benefits. The total estimated annual value of benefits gained is £104,2009.All service users have their benefit entitlements reviewed.

8 A total of £44,000 of debt was tackled through eight debt plans. Two further individuals were supported with debt, but the value of their debt was not recorded. The total has been extrapolated for all 10 individuals. 9 Benefits awarded were recorded for 16 individuals, coming to a total of £92,600 p.a. The estimated total is produced by extrapolating this figure to all 18 beneficiaries.

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APPENDIX 2: SERVICE USER CASE STUDIES

Note: All names have been changed.

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Jason is a 57-year-old man. Over 30 years ago he was involved in a road traffic accident in which he sustained a frontal lobe head injury. He now has a diagnosis of an organic personality disorder and his behaviour can be challenging. He was referred to Improving Lives from secondary mental health services following an impulsive attempt to take his own life. At the point of referral, Jason had been discharged from hospital and was living in a residential home after his previous accommodation had been condemned. He was extremely vulnerable to psychological and financial exploitation from others. Jason’s Improving Lives Support Worker helped him with a wide range of tasks. This included attending various health appointments with his GP and at the hospital. He helped Jason to successfully apply for Personal Independence Payments and accompanied him to his face to face health assessment. A focus of his support was finding Jason a new place to live. This included helping him to recover his possessions from his former home and taking them to a safe place. His Support Worker liaised with housing providers and other housing services, helping him to find, and move into, a new home. Referrals were made to charities that could give him furniture for his new flat. Finally, his Support Worker liaised with utility providers to ensure a smooth move in to his new flat.As a result of this support, Jason is now in a much happier place in his life. He is financially better off and enjoying living independently again.

Bernie was referred to Improving Lives by his Occupational Therapist as his support worker from Wellness in Mind was planning to discharge him. Bernie was a refugee who left his country of birth a number of years ago after being kidnapped and tortured while serving in the army. This traumatising ordeal left him with on-going physical pain plus severe PTSD and anxiety. Bernie struggled to function on a day to day basis. He was unable to leave his flat and drank alcohol daily to help him sleep. Bernie only had basic English which made communicating with other people very difficult. He struggled with benefits, bills and letters, and with arranging appointments. Bernie’s Support Worker quickly realised that he was being harassed by one of his neighbours. He had physically attacked Bernie on several occasions and rang his door bell day and night, triggering his PTSD. With Improving Lives’ support, Bernie was accepted for a housing transfer and his buzzer was disconnected to reduce the harassment whilst he waited to move.Improving Lives helped Bernie to access the healthcare he needed by accompanying him to various appointments. This included multiple meetings about his enduring physical pain. Bernie was very unhappy with the drugs he had been prescribed. With the help of his Support Worker he was able to address his concerns with his psychiatrist who changed his medication.Bernie’s Support Worker encouraged him to attend Improving Lives’ group activities which helped to reduce his social isolation. These positive experiences resulted in a strong and trusting working relationship between Bernie and his Support Worker and have made a

Lucy is a 62-year-old woman who was referred to Improving Lives following discharge from Highbury Hospital after being detained under the Mental Health Act. She had a longstanding diagnosis of paranoid schizophrenia. Lucy had been in and out of hospital over the years, her mental health condition exacerbated by social isolation, financial mismanagement and debt issues.Her Improving Lives Support Worker met her at her home, and quickly identified that Lucy had a physical health problem that was affecting her mobility and which she had not reported to her GP. The Support Worker immediately contacted Lucy’s GP and arranged for a new assessment of her health needs, accompanying Lucy to this appointment. Over the following 15 months the focus of L’s support was around her financial issues and

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Lucy is a 62-year-old woman who was referred to Improving Lives following discharge from Highbury Hospital after being detained under the Mental Health Act. She had a longstanding diagnosis of paranoid schizophrenia. Lucy had been in and out of hospital over the years, her mental health condition exacerbated by social isolation, financial mismanagement and debt issues.Her Improving Lives Support Worker met her at her home, and quickly identified that Lucy had a physical health problem that was affecting her mobility and which she had not reported to her GP. The Support Worker immediately contacted Lucy’s GP and arranged for a new assessment of her health needs, accompanying Lucy to this appointment. Over the following 15 months the focus of L’s support was around her financial issues and

APPENDIX 3: WHO5 WELLBEING INDEX SCORES

At the outset of support, 91% of service users had poor wellbeing, according to their WHO5 wellbeing survey scores, (with an average score of 19%). Nine of 22 service users (41%), had achieved a significant increase in wellbeing by their first review. Of the 20 with poor wellbeing at the outset, 45% achieved a significant increase. The most common topics of improvement were ‘Feeling calm and relaxed’ (55% reported improvement), feeling ‘Cheerful and in good spirits’ (45%) and ‘My daily life is filled with things that interest me’ (45%). Of the 7 individuals with three sets of scores, only 1 (14%) had shown a significant improvement by the first review, however 3 (43%) had done so by the second review. Interpreting this data is evidently hampered by the small sample sizes. However, it suggests that some progress is being made in wellbeing for many service users and that time is required to see significant changes.

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APPENDIX 4: SUMMARY OF EXIT QUESTIONNAIRE SCORES

Table 1: Feedback on the service

Definitely agree

Agree Neither

Disagree

NA

Listened to me 94% 6% 0% 0% 0%

Understood my needs 100% 0% 0% 0% 0%

Treated me like a person 89% 11% 0% 0% 0%

Did what they said they would do 94% 6% 0% 0% 0%

Table 2: Feedback on impact on clients

Definitely agree

Agree Neither

Disagree

NA

Feel happier and better in myself 47% 41% 12% 0% 0%

Feel less lonely/ isolated 44% 25% 13% 13% 6%

feel less stressed, anxious or depressed 31% 44% 13% 6% 6%

Managing mental or physical health better 25% 50% 19% 6% 0%

Attend mental and physical health appointments more regularly 23% 38% 31% 8% 0%

Better able to manage day to day life 25% 50% 19% 0% 6%

More confident to deal with problems 17% 61% 11% 11% 0%

More able to express myself clearly to other people 17% 56% 22% 0% 6%

Financially better off 56% 25% 13% 6% 0%

Home is more habitable 54% 46% 0% 0% 0%

Feel safer in home 50% 29% 21% 0% 0%

Feel more part of the community 19% 25% 44% 6% 6%

More involved in activities in the community 13% 33% 33% 13% 7%

Know more about other services that can help and when to contact them 35% 53% 6% 0% 6%

More confident to contact services when needed 29% 53% 12% 0% 6%

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APPENDIX 5: SUMMARY OF OUTCOME LADDER DATA

15 of 19 service users (79%) reported an improvement in their outcome ladder total scores from the baseline to first review, ranging from 3 to 42 points increase. Four individuals reported worsening scores. In these cases this was by only 1 point, in one case by 8 points.

% clients with positive change*

Low scores (0-5) Very low score (0-3)

Before After Before After

Emotional health and wellbeing

74% 100% 53% 47% 21%

Taking care of your health 74% 94% 63% 61% 21%

Access to Support Services 63% 68% 42% 32% 11%

Everyday Living Skills 63% 79% 58% 32% 16%

Empowerment 67% 100% 72% 56% 28%

Taking part in community life 50% 100% 70% 70% 30%

Money 67% 67% 33% 50% 6%

Housing 58% 53% 32% 42% 11%

Learning and employment 38% 88% 63% 50% 25%

*Against the total number of service users where data is entered against this category

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