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The Life Rooms – Evaluation Report December 2018

“We've got mental health issues, every one of us, in certain degrees or certain ways… doesn‟t mean we‟re crazy, it just means we‟re having difficulty coping with life”

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Contents Introduction ................................................................................................................................................... 3

Key messages: ............................................................................................................................................. 5

Life Rooms usage: an overview .................................................................................................................... 6

The Recovery College ................................................................................................................................................... 6

The Recovery College in figures (April 17 - March 18) ............................................................................................. 6

What do Recovery College students say? ................................................................................................................ 7

Recovery College developments .............................................................................................................................. 7

Pathways Advice ........................................................................................................................................................... 8

Pathways Advice in figures (April 17 - March 18) ..................................................................................................... 8

What do Pathways Advice clients say?..................................................................................................................... 9

Pathways Advice developments ............................................................................................................................... 9

Volunteering .................................................................................................................................................................. 9

Volunteering in figures (April 17 - March 18) ............................................................................................................ 9

What do volunteers say? ......................................................................................................................................... 10

Volunteering developments ..................................................................................................................................... 10

Measuring value and impact ....................................................................................................................... 11

The Life Rooms impact on the health and care system .............................................................................................. 11

The Life Rooms impact on the person, their carers and families ................................................................................ 13

How do Mersey Care service users describe Life Rooms impact? ........................................................................ 14

Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS) ........................................................................ 20

The Life Rooms impact on community ........................................................................................................................ 21

The Growth Company ............................................................................................................................................. 22

Sefton @ Work ........................................................................................................................................................ 23

National Careers Service (NCS) ............................................................................................................................. 24

Citizens Advice Sefton ............................................................................................................................................ 24

Creative Support ..................................................................................................................................................... 25

Health Trainer .......................................................................................................................................................... 26

Future ......................................................................................................................................................... 27

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

Acknowledgements .................................................................................................................................... 29

Appendices ................................................................................................................................................. 30

Appendix 1 .................................................................................................................................................................. 30

Appendix 2 – Focus group topic guide ........................................................................................................................ 31

Appendix 3 – Consent and participant information forms ........................................................................................... 32

Appendix 4 – Theme frequency information ............................................................................................................... 35

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Introduction The Life Rooms houses Mersey Care‟s Social Inclusion and Participation Team. This comprises of a number of services including a Recovery College, volunteering services, and pathways support. The Life Rooms offers a community and social model in response to mental distress. Additionally, it provides safe spaces and welcoming environments, with access to community resources such as library services, computers and café facilities. The Life Rooms offers support for those wanting to take the next steps in their life journey, whatever they may be. The Life Rooms project came to fruition when an opportunity arose to take possession of the Carnegie-designed Walton Library as a home for the team. Carnegie‟s philanthropic intent was driven by the belief that access to beautiful environments would lift people‟s spirits, give them hope, and provide them with a horizon of learning and opportunity on which to move forward in life. The ethos of the Life Rooms rings true with this Carnegie vision. It is important that the Life Rooms maintains the Carnegie philosophy of a beautiful place to be in recognition of the human significance of being afforded a positive environment. Following the opening of Walton Life Rooms in May 2016, a second Life Rooms site was opened in Southport in May 2017. A third site will open in Bootle as a joint venture with Hugh Baird College in early 2019. The below shows a summary of service developments to date:

Southport Life Rooms

The development of the second Life Rooms site has involved securing community partnerships, working with clinical services in the area and developing the service in collaboration with the local population.

Pathways Advisor service

This role was created in recognition of the challenges faced by individuals when navigating community support. The Pathways Advisors work with people accessing the Life Rooms to support them in taking their next steps; this is likely to involve both support at the Life Rooms as well as work with community partners. The Pathways team has grown quickly and is an essential component of the Life Rooms social prescribing approach.

Recovery College

Whilst it existed before the Life Rooms, the Recovery College has continued to develop with the Life Rooms model. The Recovery College has a vast array of learning and social opportunities on offer. Of particular note is the development of the curriculum to include physical health opportunities.

Life Rooms Bootle

In partnership with Hugh Baird, a third Life Rooms will shortly open. Life Rooms Bootle offers an opportunity to engage with a younger population around health and wellbeing, as well as presenting an exciting partnership between health and education.

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Integration agenda The Life Rooms continues to work hard in terms of integration within Mersey Care NHS Foundation Trust. So far, this has involved working with inpatient services to support the use of the Life Rooms and piloting a „transfer of care‟ project whereby those being discharged from clinical services are supported on this journey by the services available at the Life Rooms. Life Rooms integration work continues to develop, including exploring the Life Rooms model within secure services and working with HMP Liverpool to explore how the Life Rooms can support rehabilitation of the prison population.

Employment model

The Individual Placement Service (IPS+) sits within the Social Inclusion and Participation portfolio. The Life Rooms expands this model of employment support to ensure that those that may not meet the criteria for IPS, as well as those not requiring the intensity of this model, still have access to employment support.

Digital developments

The Life Rooms has invested in the digital social prescribing platform, Elemental, in order to better capture the individual journeys within the Life Rooms, as well as to more robustly demonstrate the impact of these journeys.

Life Rooms resources

The Life Rooms continues to expand the resources it provides to service users and the local community. This has included developing the community garden at Life Rooms Walton as well as expanding services at Southport to include access to an allotment and fully accessible outside classroom space.

Life Rooms Advisory Group (LRAG)

A big part of the Life Rooms ethos is side by side working between its diverse stakeholder group, which includes Life Rooms staff, Life Rooms volunteers, Life Rooms users, and partner organisations. LRAG works to support the development of the Life Rooms through side by side working with users and stakeholders. This report provides an overview of service usage and Life Rooms impact and value. It works through the following sections in order to do so:

Key messages: outlining of the key messages in terms of Life Rooms activity and impact

Life Rooms usage: an overview of Life Rooms activity Apri17 – March18

Measuring value and impact: a summary of outcomes in terms of the health and care system, the person and their family, and on the community (DRAFT Common Outcomes Framework for Social Prescribing, NHS England 20181)

Future: exploring what is next in terms of building the evidence base for the Life Rooms

1Accessed at:

https://www.somersetccg.nhs.uk/EasysiteWeb/getresource.axd?AssetID=6915&type=full&servicetype=Attachment

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Key Messages:

Key messages:

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Life Rooms usage: an overview This section of the report presents an overview of Life Rooms activity for the time period April 17 - March 18. In particular it focuses on the activity that has taken place within the Recovery College, the Pathways Advice Service, and Volunteering Support during this time period. Some key figures are presented that help to quantify this activity; experiences of people who have accessed the service and key developments that have taken place for each service are also included. The overall picture of visits for each Life Rooms site is shown below. Over 30000 visits have been made to the Life Rooms between April 17 - March 18. Walton Life Rooms: 20253 visits between April 17 - March 18 Southport Life Rooms: 10502 visits between April 17 - March 18 These figures reflect visits to the Life Rooms for a wide number of reasons, including:

The Recovery College

Pathways Advice

Volunteering

Accessing IT facilities

Visiting café facilities

Using the library

Professional and community meetings

The Recovery College

The Recovery College offers free courses to service users, carers, staff, and the wider community. The courses available range from supporting people to understand and manage mental distress to more social and creative offerings, some examples are listed below:

Managing anxiety

Understanding depression

Feeling better through comedy

Creative writing

Confidence Building

Yoga

Gardening

Walking

The Recovery College in figures (April 17 - March 18)

1083 new student enrolments processed

4642 individual Recovery College contacts2

52 different learning opportunities on offer

2 A „contact‟ is defined as attendance at an individual session, i.e. a course may be 4 sessions long; if an individual

students attends all 4 sessions, this amounts to 4 contacts.

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What do Recovery College students say?

A Recovery College student shares her early experiences of the Recovery College, as well as where she is now on her journey:

“I first heard about the Recovery College from my psychiatrist. My first Recovery College session was a course on confidence. My husband dropped me off at the session and I was extremely anxious, I had chosen the location as it was far enough away from my home that no one would know or recognise me. It was quite a small session with about 6 people; it was a very relaxed atmosphere. The course facilitators were so friendly and welcoming and put me at ease immediately, which helped so much. The session itself was structured with a hand out booklet to follow, but one thing I was very aware of was the flexible approach of the session, allowing people to talk and share and generally connect. It made me aware that I was not alone and lots of people experienced very similar issues. From there I attended all the courses available across different sites and then re-attended courses, just to refresh and keep my toes dipped into the magic of the Recovery College. The variety of courses available kept me interested and knowing I would potentially meet more people who I could learn new tips or tricks from was very attractive. It also filled my time with positive experiences and at the same time built my confidence and understanding. One thing I feel really helped with the courses I attended was all the facilitators had some lived experience and none of the sessions were so structured that it felt like you were at school. I couldn‟t wait to become a volunteer, which I have now achieved and haven‟t looked back. The Life Rooms have had a massive impact on my recovery and I believe it has helped me to stay well. I now regularly take holiday from my full time job to volunteer at the Life Rooms, just so I can stay in that loop… if only we could bottle it!”

Detailed findings in relation to how Mersey Care service users using the Recovery College described the impact it had on them can be found further on in the report (4.Measuring value and impact). However, in order to capture specific feedback around learning environment, facilitator competency, course content and next steps for learners, all course feedback is now collated electronically through online course evaluation forms. This process was put in place from May 2018. From May 18 – September 18 there have been 903 electronic evaluations completed. Of these completed evaluations, an overwhelming majority of students felt that the course they attended had provided opportunity for discussion of „next steps‟. Importantly, students also felt valued in sessions and that an inclusive learning environment was promoted. Feedback will continue to be captured from students in this format, which will inform the development and quality assurance for the Recovery College moving forward. Recovery College developments

Enrolments to the Recovery College continue to increase. The Recovery College team continues to engage regularly with champions of our service, particularly within Mersey Care. A marketing plan is currently underway, which includes increased use of social media channels, display of posters, further engagement in patient and carer forums, and up to date distribution lists for both internal and external contacts. The Recovery College continues to ensure quality of delivery and

Key Messages:

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opportunity is high in order to harness our most reliable source of engagement; word of mouth. Courses on offer within the Recovery College also continue to increase. Of particular note is the curriculum development that has taken place within the context of physical health. Courses such as „Healthy takeaways‟, „Food for thought‟ and „What‟s in your food?‟ allow students to make informed decisions about food, discuss the relationship between food and mental wellbeing, and try out recipes for themselves. One enthusiastic student states:

“I suffer with depression and this course has made me get up and get out and go to the course. It has also got me eating better, which makes me feel better. I do at least one of the recipes a week now.”

Also in development are courses relating to employability within the catering field. This relates to the development of the Life Rooms café, which offers the opportunity to provide voluntary opportunities for service users, and encourages pathways into employment. Outside of physical health, there is significant work taking place to develop the curriculum in an inclusive way. Courses targeted at veterans are in development; these will provide a safe place for veterans to come and share experiences to support their wellbeing. Further, a „Men and mental health‟ course has been developed to join the „Women and mental health‟ course on the curriculum, in acknowledgement of the role that gender can play in mental health.

Pathways Advice

The Pathways Advice service within the Life Rooms offers a wide range of support to individuals. A drop in service is run by the Pathways Advisors Monday to Friday 10am – 4pm within all Life Rooms sites. The support on offer is provided by Pathways Advisors or by external partners within the Life Rooms and includes the following:

Employment support

Volunteering support

Support to access Recovery College courses

Benefits advice

Housing advice

Support to access social opportunities

Pathways Advice in figures (April 17 - March 18)

1021 new registrations with the service

61% of these new registrations were Mersey Care service users

1212 Pathways Advice contacts3 took place in this time period

2023 referrals for onwards support were made, these were made up of 734 referral into Life Rooms services (including Recovery College, Life Rooms Support Workers), 203 referrals into employment support, 127 referrals into volunteering support and 959 referrals for social support (including housing, debt, benefits).

3 The majority of Pathways Advice clients only have one contact with an advisor, before being signposted to further

opportunities or support.

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What do Pathways Advice clients say?

This Pathways Advice client tells his story of coming to the Life Rooms to meet with a Pathways Advisor, and where that has led him to:

“I was a little apprehensive about coming to Life Rooms, carrying the guilt of my past and feeling weak, I was worried about how I would be welcomed, but Lydia (Pathways Advisor) was not only able to put me at ease, she gave me advice about what Life Rooms could offer and how it was a safe space for me, to be me. Coming to Life Rooms was one of the most important things I've done in my life. It's one place I can actually attend and feel at ease and relaxed, because I know that the other people around understand what it is like to feel different, to not always be comfortable in your own skin. I can have conversations about issues that people outside of Life Rooms may not understand and it's comforting and supportive to be able to discuss shared experiences with other service users, both inside the Recovery College classrooms but also outside in informal settings such as the cafe or libraries, over coffee or lunch. What has mattered to me most, and I think makes Life Rooms unique, is the access to Pathways Advisors and Support Workers. Having these people available for help, support, and guidance has been superb. I've been able to discuss problems in my own life, receive advice, support and guidance to other services where necessary, without needing an appointment or needing to see a doctor or other professional; this drop-in nature is something I haven't seen anywhere else I have lived. These relationships with the staff and with other service users have been extremely important to me and because of this I look forward to when I attend Life Rooms. I am not understating the point when I say I owe my life to Life Rooms; they have helped me with my mental health care in ways that words cannot express.”

Pathways Advice developments

The Pathways Advice service at the Life Rooms continues to develop as an essential component of the Life Rooms model. In the time period April 17 - March 18, Pathways Advisors linked clients in with over 100 organisations for support in the community (an overview of key partnerships and the resulting client outcomes is given in section 4). Key to the development of this service has been securing an appropriate platform to record and track these client journeys. The Elemental Social Prescribing platform has been developed for use by Life Rooms Pathways Advisors; this will offer providers of services - public, private and third sector - an opportunity to work together to support the delivery of social solutions across the continuum of care, and create healthy communities and neighbourhoods.

Volunteering Support is provided within the Life Rooms to individuals looking to volunteer with Mersey Care. Within the Life Rooms, people can access further information and support on how to do this, as well as undertake their volunteer interview and induction process. Volunteering in figures (April 17 - March 18)

45 volunteers (predominantly service users) successfully completed the interview/induction process and have been placed within Mersey Care

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What do volunteers say?

This volunteer tells us a little about his volunteering journey and the impact it has had on him:

“I have been volunteering with Mersey Care for the past few years, since I came out of hospital. One of my first volunteering positions was as a librarian and first person contact in the Life Rooms. When I first started, my confidence and self-esteem was at an all time low. I was unsure of myself and anxious that I would let people down, let myself down. Yet staff gently coaxed me forward and ever on. There was never any pressure to stretch myself too far, just enough for progress‟ sake. During my time volunteering with them, I was able to gain a greater appreciation for what the service had to offer to those seeking help. It is both a formal and informal place of learning. A sanctuary, even. As a volunteer, I was given the space and time needed to grow in confidence and self-respect, and realise that, yes, there is a lot I have to offer the world, there is a lot I can do. I was able to go some ways to fulfilling my potential. It helped me along my personal journey towards recovery. Thanks to my volunteering, including at the Life Rooms, I was able to gain employment as a support worker with Mersey Care, which means that I now get to look after people like me. I feel at home here. There is no stigma attached to poor mental health. If anything, it works in your favour, and I know that I am a better support worker thanks to my experiences. I have embarked on a new career path. My ambition is to become a clinical psychologist and I am on my way to getting there. It‟s a long, hard road but one I‟m willing to travel. I am due to start a conversion Masters in psychology in the New Year, which I‟m really excited about.”

Volunteering developments

Volunteers are integral to the Life Rooms service. One volunteer role that has developed in the Life Rooms is the pastoral volunteer. Pastoral volunteers provide support and compassion in the hope that someone may feel less alone. This has been a really effective role for the Life Rooms, as it has allowed staff to support a greater number of people, whilst also ensuring that individuals receive the service they need. Volunteers also play a key part within Mersey Care more widely. Volunteers are present at every staff induction to share their experiences and evidence the key role that volunteers play. More recently, volunteers have been involved in the recruitment process for mental health nurses within Mersey Care. Volunteer roles within Mersey Care are wide ranging; beyond recruitment and induction, they also include befriending, inspections and spiritual and pastoral care. A recent addition is the development of a „meal companion‟ volunteer. After undertaking their food hygiene certificate, meal companion volunteers will encourage and assist inpatients with eating and drinking. Future plans include the development of „hospital to home‟ and „carer support‟ volunteers. Routine outcome data in terms of volunteering is not currently collected. However, within the specified time period, three service user volunteers are known to have gained employment within Mersey Care. A further volunteer, recently discharged from forensic services, will shortly be undertaking a paid role within inpatient settings.

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Measuring value and impact Measuring value and impact in a service such as the Life Rooms is challenging. There is a need to demonstrate „outcomes‟, yet what this means can vary greatly as the service affords significant flexibility in terms of individual and community need. The concept of Social Prescribing can provide a helpful way forward here. Social Prescribing is a means of connecting an individual with social support within the community. It is an approach that adapts to individual and community need, and, as such, it is helpful to look at evidence frameworks for Social Prescribing when thinking about how to describe the value and impact of the Life Rooms. NHS England describes the evidence base for Social Prescribing as falling into three main areas, and encourages the use of this framework when thinking about outcomes in a social prescribing context:

Impact on the health and care system

Impact on the person, their carers and families

Impact on community

(DRAFT Common Outcomes Framework for Social Prescribing, NHS England, 2018)4 The evidence presented within this section of the report will therefore follow the Common Outcomes Framework for Social Prescribing as described. This provides a helpful tool for presenting Life Rooms impact and value in a meaningful way, and in a way that is consistent with other similar services.

The Life Rooms impact on the health and care system A service evaluation of the Life Rooms commenced in January 2018. This project was overseen and supported by the CLAHRCNWC (Collaboration for Leadership in Applied Health Research and Care North West Coast)5, which meant academic oversight was provided. A number of Life Rooms users also supported the design and implementation of this evaluation. One aspect of the evaluation specifically looked at the impact of the Life Rooms on Mersey Care service users‟ use of clinical services. The aim of this quantitative piece of work was to explore whether there is any impact on the health and care system in terms of secondary mental health care. In other words, it explored whether there is a change in secondary care contacts for those that access the Life Rooms. In order to explore this, we implemented the following process:

1. A total of 402 people were identified as using the Life Rooms in time period B – 6 month “intervention” period. For the purposes of this work, using the Life Rooms meant that 402 people attended a Recovery College course or had a Pathways Advisor appointment during time period B6.

Time period A – 1st April 2016 and 31st March 2017 (12 months) Time period B – 1st April 2017 and 30th September 2017 (6 months)

4 Accessed at:

https://www.somersetccg.nhs.uk/EasysiteWeb/getresource.axd?AssetID=6915&type=full&servicetype=Attachment 5 This research is funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied

Health Research and Care North West Coast (CLAHRC NWC). The views expressed here are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. 6 Users of the Life Rooms that used only IT, café, social or volunteering activities during this time period will not be

included in this piece of work.

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Time period C – 1st October 2017 and 31st March 2018 (6 months)

2. A matching activity was attempted with service users of Mersey Care that had not accessed the Life Rooms. The criteria for matching was demographic information, assigned PbR cluster and their level of clinical activity over time period A and B7. This left a Life Rooms cohort of 187 and non-Life Rooms cohort of 187.

3. The clinical activity of both cohorts was obtained over each of the three time periods.

4. Financial costs were attached to the activity information in order to obtain total cost

information for each cohort over each of the three time periods.

The following table shows the total amount of secondary care contacts and the total associated clinical costs over the three time periods for both the Life Rooms and non-Life Rooms cohorts. Also calculated, is the average clinical contact cost per contact for both the Life Rooms and non-Life Rooms cohorts.

Life Rooms cohort Non-Life Rooms cohort

Time period

Number of secondary

care contacts

Clinical cost

Average cost per contact

Number of secondary

care contacts

Clinical cost

Average cost per contact

A (12m): 01.04.16 – 31.03.17

1798

£253,957.94

£141.24

2022

£318,396.27

£157.47

B (6m): 01.04.17 – 30.09.17

1488

£273,735.75

£183.96

861

£155,276.67

£180.34

C (6m): 01.10.17 – 31.03.18

919

£160,617.42

£174.77

630

£122,580.54

£194.57

After the intervention period, there is a £9.19 reduction in average clinical contact cost for the Life Rooms cohort.

After the intervention period, there is a £14.23 increase in average clinical contact cost for the Non-Life Rooms cohort.

After the intervention period, the Life Rooms cohort cost, on average, £19.80 less per clinical contact than the non-Life Rooms cohort.

7 Full details of the matching process can be found in Appendix 1

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This data illustrates that those who accessed the Life Rooms in time period B incurred less clinical cost in the subsequent time period than those who did not access the Life Rooms in time period B. However, it is clear that further evaluative work is required in order to demonstrate secondary care savings in a conclusive way. This must include clinical and financial data over a longer time period and with greater numbers than is demonstrated in this evaluation. It also needs to be noted that the Life Rooms cohort incurred additional costs through their activity at the Life Rooms8; this is not included in the data above. Qualitative work was also undertaken with some of the Life Rooms cohort via focus groups (this is outlined in detail in the subsequent section); it is interesting to note comments from participants within the context of the Life Rooms impact on the health and care system. Some participants talked about their goals of moving away from secondary care and decreasing medication, and no longer identifying as needing formal therapeutic intervention: “(my goal is)…moving away from the Hesketh Centre… erm being under my GP”

“I hope that my medication can get decreased over time”

“…that‟s what this place has given me more than anything else. Yeah I go and see a psych‟ once a month… you know… the therapies that I was meant to be getting I don't even think I need any more. Which is quite good - it turned out the referral never went through… but I don't think I need them because I think I've done enough work coming here on myself to… to have a good enough understanding, to know about how my illness works, now that I can see the signs and stop bad things happening. But also, I can see it in other people.”

Evidence collection in terms of the Life Rooms impact on the health and care system is at early stages, but this evaluative work shows some promising signs. As mentioned previously, creating an evidence base for a service such as the Life Rooms, particularly in health economic terms, is a significant challenge. There are examples at a national level of social prescribing schemes exploring change in hospital bed days or GP attendances after receiving a social prescribing referral, but this data is early and exploratory. The method and data shown here offer one way in which health economic evidence can be collected for the Life Rooms, in the context of secondary mental health care activity. Perhaps, more significantly, this evaluation work has offered significant insight and learning for the continuing development of the Life Rooms evidence base. Further work on the impact of the Life Room on secondary mental health care is clearly needed; exploring how the Life Rooms impacts on the primary care system would also make an interesting future venture.

The Life Rooms impact on the person, their carers and families

In terms of impact on individuals, the evaluation work described above also included a qualitative element, which explored whether Mersey Care service users identified the Life Rooms as having an impact on their recovery journey. This provided rich experiential data in relation to Life Rooms impact on individuals, in particular Mersey Care service users. Additionally, since June 2018, all people accessing the Life Rooms have had the opportunity to complete the Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS). The SWEMWBS measure enables monitoring of mental wellbeing in Life Rooms users and is therefore relevant for this section of the report. Both of these data sources are presented below.

8 For example, the cost of accessing a Recovery College course or receiving Pathways support.

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How do Mersey Care service users describe Life Rooms impact? From the cohort of 187 Life Rooms users whose clinical activity was tracked, 18 participated in semi-structured focus groups to explore their experiences of the Life Rooms. Topic guides were co-produced with Life Rooms users9 and participant information sheets and consent forms were used10 to ensure participants understood the purposes of the evaluation and were happy to be audio recorded. The focus groups were co-facilitated with Life Rooms users; this approach was effective in creating a relaxed context for the conversations. The co-facilitators also shared their experiences as part of the group discussions, which served to build group confidence and encouraged participants to be open and honest. The focus groups were audio recorded and transcribed. Thematic analysis of the transcripts was undertaken by Life Rooms users and staff together11. As with the quantitative evaluation work outlined above, this project was overseen and supported by the CLAHRCNWC (Collaboration for Leadership in Applied Health Research and Care North West Coast), which meant academic oversight was provided12. The following discussion evidences the main findings from these focus groups that relate to Life Rooms impact on individuals:

Life Rooms vibe: “Yeah it doesn‟t smell of TCP does it?” Participants spoke in detail about the “vibe” of the Life Rooms. For them, a number of aspects contributed this, including feeling understood, the relaxed atmosphere, being able to just „be‟, and feeling safe. The most significant contributors to the Life Rooms “vibe” for participants were people and environment. The people that make up the Life Rooms (the staff, the volunteers, the Life Rooms community, partner organisations) were consistently cited as an important part of participant experiences, and a clear indicator of Life Rooms “vibe”.

“…you‟re made to feel part of the family cos it‟s like a family here it‟s not just a service it‟s a family group you feel like you‟re part of a family” “I've always said it‟s just such a safe place because, even if I‟m not in a good mood, get out and at least go to the Life Rooms where I know other members of staff and students and service users… you know everybody understands, do you know what I mean?”

It was significant for participants that, within the Life Rooms, there was always someone to have a chat with. The comments in this regard, gave a sense of availability and approachability amongst Life Rooms people, which had a positive impact for participants:

“It‟s knowing that there's something that you can go to talk and people get ye, they understand ye, they don't think oh my god look at this nutter”

9 Full topic guide can be found in Appendix 2

10 Consent form and Participant Information Forms can be found in Appendix 3

11 A full overview of theme frequencies and how they were derived can be found in Appendix 4

12 This research is funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied

Health Research and Care North West Coast (CLAHRC NWC). The views expressed here are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

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“…she spoke to me about all my problems and how I was getting on. All very informal and I can cope with that, but I couldn't cope with talking to a doctor looking at the time all the time” “You come in and it‟s just „hiya, are you ok?‟ It‟s not anything strange do you know what I mean?”

Further, Life Rooms people were described in a way that encouraged a sense of validation for participants. Validation in terms of personhood and being treated in a human way, but also in the sense that Life Rooms people validated their experiences and treated them seriously:

“…you know what I mean, it‟s all first names and you know after a week or two of you being here, people remember your name.” “The fact that there‟s people with lived experience working here, and even the staff that don‟t have lived experience – I think it goes back to what we said before – they don‟t treat you differently. They don‟t treat you like you‟re a patient, they treat you like you‟re just a person and I think that makes a big difference… Because when you‟re here you feel that right across the board… it‟s just across the board that there‟s always that caring atmosphere when you‟re here. And that does mean a lot. „Cause you can feel when you‟re actually under a lot of mental health issues that nobody cares.” “People are so helpful, they always go the extra… they‟re not like „oh that‟s not really my remit I shouldn‟t really be bothering with that‟… fob you off… they all try and they try and help you. If they can‟t help you they find someone who can, you know what I mean?”

Being treated as a person, as an individual, and having your experiences taken seriously was sometimes framed as a contrast to other experiences of services:

“When we walked in this morning and (receptionist) went „Ahhh, you‟ve been really missed!‟ and she was there with that lovely welcome and that big beaming smile that she‟s got… you know where else would you get that? You could go to another place and not go there for three weeks and they wouldn‟t even notice. But as soon as she seen me this morning she was you know…”

Clearly, the people that make up the Life Rooms had particular significance in creating the Life Rooms “vibe”. For some, this was emphasised because this was not the experience they got elsewhere. The same is true of the Life Rooms environment. The environment was consistently cited as an important part of participant experiences, and a clear indicator of Life Rooms “vibe”. Participants described the positive effect of the environment in terms of how the building looked, felt and smelt:

“I was amazed by the colour scheme and the first thing that hit me when I came in after I was asked to sit down and was waiting for the Pathways Advisor to come and speak to me was the colour scheme and noticed the lovely light green” “You know when you come here it is a nice environment. It‟s a safe environment and it‟s different. It‟s not a clinic, is it? It‟s not like a day centre.” “… the whole atmosphere is calming”

“…yeah it doesn‟t smell of TCP does it?”

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Environment in this sense refers to the physical environment; the building/fixtures and the non-clinical feel. Also important to participants was the „purpose‟ of the environment. The bringing together of support „services‟ with community facilities such as a café or library is significant for some participants. In particular, the inclusion of café facilities alongside support services encouraged a more informal, comfortable feeling:

“…you know what I mean exactly you're not in a waiting room and you're not like just in a café, it's everything isn‟t it?”

Life Rooms essence: “I don‟t know your story and you don‟t know mine but we both know that we share similarities” Beyond talking about the impact of the service in terms of “vibe”, focus group participants were encouraged to talk about what they got from the Life Rooms. They described this both in terms of the actual support or service they received, and also what about this support was particularly significant for them. Hence why this section is being referred to as Life Rooms “essence”; it attempts to unpick some of what people identify as essential to the Life Rooms model. Overall, this encompassed a number of different aspects, including being able to go at your own pace, drawing on lived experience to support others, a context of choice, and simply being different to other services. The most significant contributors to the Life Rooms “essence” for participants were shared experiences and the non-judgemental culture. These are explored in more detail below. Participants made reference to the Life Rooms providing a context in which shared experiences are facilitated, specifically in terms of the Life Rooms providing a space in which people can tell their story, be honest about how they feel, and support and empower each other. In this sense, participants felt that a sense of community and shared learning was created within the Life Rooms, and this significantly contributed to what they got from the service:

“…and it‟s not just seeing me progress, it‟s seeing so many other people progress as well.” “You pick up as much off the (other) students… do you know what I mean? So you're constantly topping up your own coping strategies?” “…and you can give your advice and your skills to other people, and that‟s what it‟s all about isn‟t it? And you feel better 'cause you‟re giving something…” “It‟s amazing how service users push you and encourage you to go on to other courses which you would never have possibly known about or decided you wanted to do and that‟s how this progresses, isn‟t it? So your confidence builds as a result of that.”

Whilst there are specific examples of shared experiences occurring explicitly, there are also numerous examples of implicit shared experiences. People spoke of the role of familiarity, a sense of belonging or „finding your tribe‟ as well as unspoken connections with peers:

“And coming here‟s different. It‟s really interactive. Everyone gets to know each other. You build friendships, as well… like you see people, like when you walked in today, you recognised me from a course that we done together and I recognised you from a course that we done together and even though it might not be someone that you‟ve sat and had long conversations with… but just seeing a friendly face of someone that you‟ve been with

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before relaxes you. Straight away you feel more comfortable about whatever it is that you‟ve got to do because you‟re not on your own and you‟re doing it with someone that you‟ve done stuff with so you know that that person‟s okay… it‟s kind of like an unspoken bond I suppose (laughs) – do you know what I mean? It‟s like a… er… connection because you‟re in the same boat. And the beauty of it is that you don‟t need to know the ins and outs – like I don‟t know your story, you don‟t know mine, but we both know that we share similarities.” “Sometimes it‟s not about sitting there and telling people how you're feeling or telling or listening to other people‟s feeling, it‟s just knowing that you're surrounded by people who are the same, do you know what I mean?”

Alongside shared experiences, the non-judgemental culture was the other most significant contributor to Life Rooms “essence” for participants. Participants spoke at length about the Life Rooms having a normalising presence within their lives; for them, this included not being judged, not being labelled, and being treated as an individual.

“With the Life Rooms, you can actually, if you walked into a group that were in the Life Rooms you couldn‟t go she‟s staff and they‟re users „cause you don‟t know because it‟s not dwelled on, is it?” “To actually come in and not feel judged… You‟re accepted for who you are, and as you said, you‟re amongst people that have been through it.” “If you come in here, you‟re treated as a person. There‟s no „well you‟ve got that side of mental health and you‟ve got that‟ – it‟s not that, it‟s that you‟re just treated as an individual.” “I know this is a place where if it gets like if… if it gets bad, I can come and talk to someone who will have me as, as what I am. They won‟t tell me that I‟ve got to turn into something else.”

Participants valued the non-judgemental culture that they experienced at the Life Rooms, which allowed them to be themselves, exist without a label, and offered a blurred picture in terms different Life Rooms identities.

Life Rooms impact: “Oh my god, this is the first time in my adult life I have sat and had lunch with a friend” How participants framed the impact of the Life Rooms was wide ranging. Some participants spoke about a „change in perspective‟; they felt that their previous viewpoints on themselves and their lives were changing in a positive way. Wider impact beyond individual participants was also discussed; this included improving relationships within families and passing on coping strategies to others around them. Three components of „Life Rooms impact‟ were most commonly referenced by participants: Self-development, self-awareness and social inclusion. In terms of „self-development‟, reflections about individual progress were prevalent within the focus groups, particularly in relation to practical changes that had occurred for them. Participants were asked about things that had changed in their lives since coming to the Life Rooms; responses included not feeling the need to sit by the door within a Recovery College course, being

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able to get dressed and leave the house, and being able to complete day to day tasks independently:

“…and then I‟d sit, I‟d have to sit facing the door, and then gradually as the course went on it was, erm, Treasure your Wellbeing, and as the course went on I ended up on the opposite side of the table with my back to the door (ha) and everything it was good.” “…well I‟m out of bed, I‟m dressed, erm, depending on the day whether I‟m able to cope with the shower but, er, certainly washed, dressed and, er, today I‟m out the house, I‟m here you know.” “…you know I‟m able to go in and actually do my shopping instead of having to rely on people, getting my independence back is huge for me yeah…”

For many participants, self-development consisted of building skills and strategies, particularly in relation to mental health. This included developing confidence and self esteem or learning how to relax:

“I wouldn‟t have been able to do it if I hadn‟t have gone to Life Rooms 'cause Life Rooms… it give me the… as I say, it‟s given me coping mechanisms, it‟s given me strategies, and its helped me to get the confidence and self-esteem 'cause I was I was… oh I was at rock bottom”

“The Life Rooms saved my life you know... it really was... it was a big turning point. I said I have a totally different outlook on life due to… you get to talk to people and you‟re getting these mechanisms where you can cope and you become yourself”

“…if someone‟s, like, learning about depression, learning about anxiety… even if you just get one or two good bits out of it, out of a two hour thing, it‟s worth it… and, as I say, its, sometimes you can just reinforce your views and go yeah well I do need more help, or… you know… maybe I can do something else… erm… 'cause I found a wellbeing class was great… er… the wellbeing class and even the mindfulness class where you could learn to relax 'cause that‟s another thing you forget how to do is relax 'cause your mind‟s constantly… washing machine‟s going or you‟re looking after your lad and you don‟t get no time to relax”

Self-awareness was also key in terms of Life Rooms impact. Participants spoke about how the Life Rooms had facilitated a process of self-exploration and learning, which for many included being able to recognise their own strengths and weaknesses and being able to face life‟s challenges:

“…and speaking to people, I've got more awareness of me and where I am in my head so I know now if I‟m starting to fall down… so I know to try and get my coping strategies in place.” “I feel as if I‟m getting a little bit stronger day by day, but you know you do get them knockbacks and bad days etc. but being stronger as a person and trying to, you know, face the difficulties. It takes a lot, but I know the rewards are worthwhile „cause I feel good.”

Self-awareness was significant for many participants because it allowed them to change their behaviour in order to manage their distress more effectively, for example through understanding

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when they needed help or being able to communicate their needs:

“When I relapsed last year I got to a point where I knew I wasn‟t right so I went and asked for help before I hit a point where I tried to take my own life. And for me that was such a massive thing to actually see it coming this time… I think coming here has taught me so much about my illness and about how to look after myself that – although I was disappointed about having to go back into hospital – I was also proud of myself for realising that I needed to go back in before I got to a point where it was kind of taken out of my hands.” “I‟m now seeing things differently about myself… Since doing these courses I understand my illness more and I understand if I‟m having a bad day… It‟s also helped me be able to voice things better as well. I can tell people more about my mental health. I can tell them I‟ve had a crap day; I‟ve had a good day. Even if it‟s the middle of the night and I‟m struggling, I know that there are people that I can phone and just say „I‟m not feeling great.‟ So that‟s how it‟s helped.”

This last participant evidences the power of not being alone in your distress and also exemplifies how having self-awareness can support better relationships with others. This brings us to the third main theme that came through in the focus groups in relation to impact: social inclusion. Participants emphasised the importance of social inclusion, particularly in reference to not feeling alone and having the opportunity to build relationships within the Life Rooms:

“When you‟re going through a mental health thing you do, you feel so isolated – you‟re the only person that this has happened to – until you come to places like this and you think, „Oh… I‟m not you know‟… that feeling of isolation can sort of go then, can‟t it? It just makes you feel nice, doesn‟t it? It makes you feel well.” “It lifts my mood and it makes me feel not so like, isolated, like there are other people out there. I‟m not on my own.” “And doing the little groups and like my Walking Group and whatever else, I‟ve built up a couple of little friendships, you know? If one of us isn‟t there one week it‟s „oh where‟s such and such?‟ It‟s just nice to know that someone‟s worried about me „cause I wasn‟t there last week, you know?” “On a few of the courses I met a, I met a girl there, I say girl she's the same age, you know she's a woman, I met someone there and we clicked and we had lunch in, in the little coffee shop there and it was like oh my god this is the first time in my adult life I have sat and had lunch with a friend”

Clearly, social inclusion offers significant impact on participants‟ lives. By offering a safe environment that is conducive to community and relationship building, Life Rooms users are empowered to pursue a version of social inclusion that is meaningful to them.

Moving forward: “it got me back on the ladder to go back to work” Another way in which participants described Life Rooms impact was in the way it shaped their personal goals for the future. Participants described feeling more confident to work towards their personal goals after engaging with the Life Rooms, this included working towards employment,

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coming off benefits and pursuing further hobbies and interests:

“Do you know what I've never really (thought) that I could do a job but…having just…I've only been going a few weeks, but I‟m seeing people there and the confidence it‟s given me I really feel like I‟m ready now, at 54 (laughs)” “It got me back on the ladder to go back to work… to feel confident to go back to work knowing that I could cope with work… I could… and I could cope with life” “So I‟m looking… I‟m aiming to go back to work within six months…if I can get myself back on track I want to do what you're doing, voluntary and then hopefully get myself a job” “Well when I first come… erm… I got asked if I wanted to run my own group 'cause I spoke to a few of the people who work here about my experience… and I am looking for paid work eventually 'cause that‟s what I want… to get myself back in to paid work 'cause I‟ve been on income support for coming up to four years… it‟s been really hard… you know… and I want to take my son on holiday… you know… I‟d like to work again as you get that like self-esteem back”

“…and not until I come back to the Life Rooms have I been able to get on stage because I‟ve had such terrible stage fright and this place has given me the confidence back that I‟d lost so long ago… and I think that‟s what The Life Rooms for me has done, is give confidence. Not just to be in here with people that understand me but to go out to the wider world and say oh sod you I don‟t care what you think, I‟m ok.”

It is clear from exploring the main themes from the qualitative data that, for these participants, the Life Rooms was a significant factor in their recovery journey. In terms of impact on the person, therefore, this is a really strong starting point for the Life Rooms evidence base in this context.

Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS)

SWEMWBS data is also relevant for Life Rooms impact on the person. The SWEMWBS measure enables monitoring of mental wellbeing in Life Rooms users when they access a Pathways Advisor, and at a subsequent review period. 125 pre-SWEMWBS were completed with Life Rooms users between June – November 2018. A post-SWEMWBS was obtained for 30 Life Rooms users at a 3 month review period. The analysis below reflects the outcomes reported for these 30 Life Rooms users. An improved score is demonstrated by a positive change in the metric score, deterioration is demonstrated by a negative change in metric score.

Change in SWEMWBS Metric Scores

Measure Pre- Post-

Mean average metric score 16.08 18.18

Standard deviation score 3.98 3.54

Mean average change N/A 2.11

Maximum negative change in metric score N/A -4.5

Maximum positive change in metric score N/A 12.25

Pooled standard deviation N/A 3.76

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Effect size N/A 0.56

Medium Improvement

% with improved score (0.5 point improvement)

N/A 50.00%

15

% no change N/A 30.00%

9

% with worse score (0.5 point deterioration) N/A 20.00%

6

The above analysis shows that the effect size of the intervention (the Life Rooms) evidences an overall medium improvement for this dataset.

50% of the dataset showed an improved metric score upon review

Overall, the dataset shows a mean average change of +2.11 in the metric score As with the other data collection methods, the Life Rooms SWEMWBS dataset requires expansion in order to be able to make conclusions with greater certainty. However, this presents a positive start for wellbeing outcome measurement within the context of the Life Rooms, and adds greater weight to the story of Life Rooms impact on the individual that was illustrated through the qualitative data.

Life Rooms impact on community The final framing of Life Rooms impact involves exploring how the Life Rooms affects the

communities it operates within. One of the significant successes of the Life Rooms model has

been the way it collaborates with community organisations in order to provide more effective

16.08 18.18

2.11

-5.00

0.00

5.00

10.00

15.00

20.00

25.00

Life Rooms SWEMWBS

Change in SWEMWBS Metric Scores - Life Rooms

Average Pre- MetricScore

Average Post- MetricScore

Average change metricscore

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support and shift the traditional care provision model. This is key to the Life Rooms Social

Prescribing approach; building cross sector pathways of support in order to strengthen the wider

health and care system. Between April 17 – March 18, 2023 referrals for onwards support were

made by Pathways Advisors, these were made up of 734 referral into Life Rooms services

(including Recovery College, Life Rooms Support Workers), 203 referrals into employment

support, 127 referrals into volunteering support and 959 referrals for social support (including

housing, debt, benefits).

The information presented in this section evidences some of these partnerships. All of the organisations listed utilise Life Rooms sites in order to deliver their support, meaning they have a physical presence within the Life Rooms environment; this promotes positive relationships with Life Rooms staff and users. These partnerships serve to evidence how the Life Rooms model has supported new relationships between health and third sector organisations in order to strengthen the community offer and build resilience amongst community members. Whilst the following information presents a comprehensive picture of support opportunities, it is also important to note that there are many more partnerships that form the Life Rooms model.

The Growth Company The Growth Company offer 1:1 support to Liverpool residents who are experiencing barriers to gaining employment. The programme involves up to 12 months of tailored support to job search and develop job relevant skills, followed by 6 months of follow-up support to ensure that clients are properly supported once they gain employment. This is a strong partnership within Walton Life Rooms; the service has reported many positive outcomes for those that have been referred by Pathways Advisors. The Growth Company partnership in figures (April 17 - March 18)

79 referrals made from Pathway Advisors to the Growth Company

71 referrals accepted by the Growth company

7 clients completed the full programme

18 clients supported to complete CVs

15 clients supported to complete job searches

7 clients actively applying for jobs

8 clients have gained employment

3 clients secured voluntary roles

12 clients given interview skills support

5 clients referred to the National Careers Service for further support

What do The Growth Company clients say?

“So far my interactions with (the Growth Company) have been positive. It has been helpful to have somebody to support me looking for jobs. Looking for work is time consuming and difficult so it useful to have her helping me in this area.”

What do The Growth Company staff say?

“I highly recommend the support you offer at The Life Rooms and encourage all of my clients,

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colleagues and partners to get involved as much as they can. You offer such a fantastic service to the community. All Life Rooms staff have been extremely helpful and accommodating to me and my clients. I get amazing feedback from all my clients who attend the courses/groups here and its positively changed so many people‟s lives for the better. I have an excellent relationship with the pathways advisors, we regularly cross refer and keep each other updated on client progress/changes. You all are always extremely helpful if I ever need anything and will always invite me to events being held. The facilities here are excellent, my clients regularly use the IT suit to job search, they comment on how nice the food is from the café. Even if they aren‟t on a course they will come along for a coffee and a catch up and this is great to improve their socialising. I really appreciate you letting me be a part of the service here and feel lucky that we have this support available for the community and our customers.” Sefton @ Work

The partnership between the Life Rooms and Sefton @ Work has proved to be one of the most successful employment partnerships serving the Sefton community. The partnership involves providing clients with 1:1 confidential appointments with an advisor to explore and meet employment goals. Sefton @ Work hold appointments within Southport Life Rooms every Friday and support clients with employment related activities, such as CV writing, interview skills, job searching, job applications and also employment related training. Referrals are made via Pathways Advisors who have had their needs assessed during a 1:1 Pathways appointment. Sefton @ Work partnership in figures (April 17 - March 18)

19 referrals made from Pathway Advisors to Sefton @ Work

19 referrals accepted by Sefton @ Work

4 clients supported to complete CVs

4 clients supported to complete job searches

3 clients actively applying for jobs

1 client has gained employment

2 clients secured voluntary roles

2 clients given interview skills support

2 clients given additional training

What do Sefton @ Work clients say?

“I think that the Life Rooms is the best thing to happen to Mersey Care. My experience working with Sefton @ Work has been very good. Attending appointments with him has impacted me positively, as he has shown me new accessible ways to use various applications on my smart phone and he has helped me create my CV in an accessible format. Sefton @ Work has helped me look for voluntary work and has helped raise my confidence levels in this area. Sefton @ Work provides me with constructive action plans to take away with me so that I can continue to work on things when I am at home.”

What do Sefton @ Work staff say?

“Sefton @ Work‟s outreach team have been working in partnership with the Life Rooms in Southport since October 2017. We have conducted numerous internet based job search sessions for our clients utilising their IT suite. We also have an Advisor seeing clients on a 1:1 basis every Friday. Having the opportunity to have an interview room ideally located in the

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heart of Southport has been a major asset to Sefton @ Work. The working relationship between Sefton @ Work and the Life Rooms has been very productive and we have taken many referrals from the staff at the Life Rooms. We have also introduced our existing clients to the centre. Staff have remarked how welcoming the building and staff. We hope this relationship continues to prosper.” National Careers Service (NCS)

The Partnership between the Life Rooms and NCS was established in August 2017. The partnership involves referring clients for a 1:1 appointment with an NCS Advisor. The advice and support offered includes CV production, interview technique support, job search assistance and referring onto further training and education. Appointments are currently held fortnightly within Walton Life Rooms. The partnership is unique as referrals are not dependent on the postcode or personal situation of the clients, meaning that barriers to employment support are removed.

NCS partnership in figures (April 17 - March 18)

46 clients referred from Pathways Advisors to NCS

What do NCS clients say?

“My experience using the National Careers Service has been lovely as it has allowed me the opportunity to meet with an advisor face to face. I have had two appointments and he has helped me write my CV to a good enough standard to get an interview. (NCS) has given me support in regards to how to put appropriate information onto my CV that is appropriate for a UK market.”

What do NCS staff say?

“I feel the partnership with the Life Rooms is very beneficial to both parties. The feedback received from customers and staff has been excellent. Customers who access the service have felt that the advice and guidance received has been really useful in helping them move forward in their recovery. Advice and guidance has ranged from things like advice with interview techniques, job search techniques, actual assistance with job search and setting up job alerts and the production of CVs to use when job searching. Customers who have gained employment have been very complimentary about the help and support they have received. Some customers are not yet ready to move forward but have been grateful to discuss their options and ideas as they progress. The relationships developed with the staff are excellent. We are provided with diaries in advance, usually 24 hours, and staff are extremely welcoming and supportive. Also, this is an excellent venue in which to work, we always have a place booked and there are confidential booths available if required.”

Citizens Advice Sefton

The partnership with Citizens Advice Sefton consists of advisors attending the Life Rooms on a weekly basis to provide 1:1 appointments for clients. The partnership also extends to booking appointments directly with advisors in the Bootle Citizens Advice office when needed. Citizens Advice Sefton partnership in figures (April 17 - March 18)

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242 referrals made by Pathways Advisors to Citizens Advice Sefton

160 clients seen by Citizens Advice Sefton

119 clients supported with benefits and tax credits

15 clients supported with Universal Credit

2 clients supported with consumer goods and services

18 clients supported with debt

9 clients supported with employment

5 clients supported with financial services and capability

5 clients supported with health and community care

13 clients supported with housing

1 client supported with immigration and asylum

5 clients supported with legal issues

4 clients supported with relationships and family

5 clients supported with tax

26 clients supported with travel and transport

26 clients supported with utilities and communications What do Citizens Advice Sefton clients say?

“Last year I spent a period of time as an inpatient in Clock View Hospital. Whilst I was there I was assisted by a representative from Bootle CAB in successfully applying for ESA and PIP. After leaving hospital in January I recently received a letter from the DWP requesting my attendance at a Health Assessment interview along with a lengthy form to complete. As a regular attender at the Life Rooms Walton I approached a Pathways Advisor for advice on the best way to approach this. She subsequently contacted Citizens Advice Sefton on my behalf and the gentleman I saw at Clock View was luckily available to see me again. When I met him at the Hospital we completed the form and since then I have both attended the interview and had a positive outcome regarding my ESA claim. This reduced my anxiety and has allowed me to plan more effectively for my future.”

What do Citizens Advice Sefton staff say?

“This partnership is needed and it works. Often I am able to offer reassurance to anxious clients and point them in the right direction and I feel that the appointments are absolutely beneficial to client recovery. One of the main areas I support clients with is to help them reinstate their benefits, or ensure that they are being paid the correct amount. This is a massive stress reliever for clients and often means that they and up with some level of disposable income.”

Creative Support

The partnership with Creative support involves referring clients directly to an assessment drop-in that takes place with a housing advisor every Friday afternoon in the Life Rooms. The service involves providing 1:1 tailored support to clients with housing needs in the North Liverpool Area. This support includes welfare rights, money management, and Property Pool applications and bidding support. Pathways Advisors maintain regular contact with the housing advisors from this service, via weekly catch-ups and email updates. This partnership is particularly strong and our clients report having received appropriate and beneficial support from the service. Many clients have been successfully rehoused and have been supported to avoid homelessness, debt and social isolation.

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Creative Support partnership in figures (April 17 - March 18)

61 referrals made by Pathways Advisors to Creative Support What do Creative Support clients say?

“I have attended (appointments with) Creative Support (and as a result) I have noticed an increase in my confidence (and) self esteem. I have been happy with how the service is run and wouldn‟t change a thing”

What do Creative Support staff say?

"We have been really happy hosting our weekly drop in session and working in partnership with Life Rooms and particularly the Pathways Advisors. We regularly receive appropriate referrals so we are able to maximise the support we can give to service users in the North Liverpool area. Furthermore, we often use the Life Rooms as a base for supporting our service users as there are great facilities on hand which can be used and other activities or educational groups that service users can be referred into to maximise their overall support. All of the staff at the Life Rooms are always on hand to help and could not be more accommodating. Thanks for all your support!" Health Trainer

The Health trainers offer 1:1 advice to clients in relation to a number of lifestyle factors, to help improve physical and mental wellbeing. The areas covered include managing alcohol intake, healthy eating, sleep hygiene and increased physical exercise. The Pathways Advisors have established a strong working relationship with the Health Trainer service and this is one of the most popular partners for clients to request a referral to. Regular tailored support for clients helps them to feel encouraged and empowered to make positive steps to improve their lifestyle choices. In particular, clients have reported being able to manage their sleeping patterns more effectively which has had a positive impact on their emotional and mental wellbeing. Health Trainer partnership in figures (April 17 - March 18)

77 referrals made by Pathways Advisors to Health trainers

22 clients engaged with the Health Trainer service

19 clients completed health plans What do Health Trainer clients say?

“The health trainer helped me with my diet and fitness programme and was very friendly. Attending the Life Rooms has increased my confidence and brought new skills.”

What do Health Trainer staff say?

“I love it here in The Life Rooms (Walton), when you walk in you are met with a friendly atmosphere. I‟m based in a lot of different locations (GPs, Addiction centres etc.) because I‟m an agile worker; but the majority of my referrals come from Pathways. When I am working with other people in the community I bring them into the Life Rooms of my own accord and I in turn

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make referrals to the Pathways Advisors and Recovery College. I feel very comfortable and welcomed by all the staff, I love all of them, nothing is ever a problem and they go above and beyond. The building itself is calm and relaxed; it provides a safe environment for people and some clients request to meet me here instead of an office.”

The partnerships presented evidence the work that the effective relationships between the Life Rooms and external organisations detail in regards to how this has impacted users of the Life Rooms as well as the external organisations has also started to engage. As mentioned in some of the testimonies, the Life Rooms provides resources for these organisations including space to see clients and access to the wider Life Rooms facilities. These resources also extend to the local community more generally, with facilities such as IT, library and café also providing opportunity for positive impact on the wider community.

Future Looking to the future in terms of evidence collection, it is clear that there is a need to continue to explore the evidence base for the Life Rooms. It is important that this is done using diverse methodologies, reflecting the unique approach of the service. Understanding the impact of the Life Rooms at system level, community level and at the level of the individual requires flexible, and sometimes competing, approaches in order to build a comprehensive evidence base. Evidence requirements should never be a barrier to maintaining the ethos of a human and compassionate service. It is only with approaches that take all of this into account that the conversation around impact and value of the Life Rooms will be meaningful. With this in mind, future evaluation and research work will aim to explore the following areas:

Continued development of evaluation work in relation to the Life Rooms impact on health

and care systems, including further exploration of secondary care impact as well as looking

at how Life Rooms impacts within a primary care context.

Progressing individual outcome data by continuing to utilise the SWEMWBS measure,

alongside the development of a bespoke outcomes measure with Life Rooms users.

Maintaining a strong qualitative approach that involves meaningful engagement with users

of the Life Rooms and their experiences.

Further exploration of how we can evidence Life Rooms impact on community.

The Life Rooms model challenges standardised service provision. It provides something that can, at times, be difficult to define. It consistently operates in the gaps between services, whether that be at early stages of distress, supporting individuals to manage conditions, or providing support to those far along on their recovery journey, where traditional services can drop off. Evidencing the value of a service that operates in this way can take a significant amount of time and multiple approaches. The Life Rooms has plans in place that acknowledge and work with these challenges. Looking to the future in terms of service development, there are exciting plans underway. Life Rooms Bootle presents a unique opportunity to collaborate with an education facility, and develop the Life Rooms model in a different context. The next focus will be the Central and South areas of Liverpool, exploring how resources can be secured to provide these communities with access to the Life Rooms. Within Mersey Care, Life Rooms within secure services will be a significant service development step, as will supporting our prison population via the Life Rooms approach. Finally, the introduction of the digital social prescribing platform, Elemental, offers a promising way

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forward in terms of recording individual journeys within the Life Rooms and more robustly exploring Life Rooms impact.

Conclusions This report has provided an overview of Life Rooms service usage as well as exploring the current evidence in terms of Life Rooms impact and value. From April 17 – March 18, the service usage data for the Life Rooms is indicative of a popular and developing service. Of particular note is the significant engagement from Mersey Care service users (61% of registrations to the Pathways Advice service in this time period were made by Mersey Care service users). Additionally, collaborative working with external organisations begins to be evidenced by the amount of referrals made by Pathways Advisors into community support (2023). In terms of measuring value and impact of the Life Rooms service, there is early evidence to suggest a small reduction in use of secondary mental health care after using the Life Rooms. This is illustrated through a reduction in clinical cost when compared with Mersey Care service users who did not use the Life Rooms. Alongside this, experiential data from service users that have used the Life Rooms offers rich insight in terms of how they identify impact. We learn that Life Rooms people and environment are felt to be positive influences, as well as the Life Rooms being felt to be a non-judgemental and a safe space to share experiences. Self-development and self-awareness are identified as significant outcomes for users of the Life Rooms, as well as the opportunity to build positive relationships with others and develop personal goals. We can also see that those Life Rooms users that have completed SWEMWBS outcome measures, there is indication of a medium effect in the context of improved wellbeing. Alongside outcomes that relate to individuals and systems, Life Rooms impact on community has begun to take shape through the positive relationships with community partners. The evidence base for the Life Rooms will continue to be explored with diverse methodologies that reflect the approach and ethos of the service.

If you would like to learn more about this evaluation report please contact: Clare Rotheram: clare.rotheram@merseycare.nhs.uk If you would like to learn more about the Life Rooms then please contact: Liferooms@merseycare.nhs.uk – 0151 478 6556 www.liferooms.org

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Acknowledgements

The Growth Company http://www.growthco.uk/ Sefton @ Work http://www.seftonatwork.net/ National Careers Service (NCS) https://nationalcareersservice.direct.gov.uk/ Citizens Advice Sefton http://www.seftoncab.org.uk/ Creative Support http://www.creativesupport.co.uk/ Health Trainer (Live Wire Warrington) https://livewirewarrington.co.uk/ CLAHRC NWC http://www.clahrc-nwc.nihr.ac.uk

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Appendices

Appendix 1 – Quantitative methodology

A total of 402 people were identified as using the Life Rooms in time period B.

Time period A – Between 1st April 2016 and 31st March 2017 (12 months) Time period B – Between 1st April 2017 and 30th September 2017 (6 months) Time period C – Between 1st October 2017 and 31st March 2018 (6 months)

This was narrowed down to a cohort of 331 who were verified as Mersey Care service users. The cohort of 331 Mersey Care service users that had attended the Life Rooms in time period B were matched with other Mersey Care service users that had similar levels of clinical over time periods A and B. This was done by looking at the following variables: Contact type13: Community contacts Outpatient contacts Inpatient bed days IAPT contacts Speciality: Learning Disability Adult Mental Illness Forensic Psychiatry Old Age Psychiatry Eating Disorders Liaison Psychiatry Psychiatric Intensive Care Perinatal Psychiatry Activity count: 1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 100+ Cluster grouping: Clusters 1-4 & 11: functional non-psychotic or low symptoms, low severity Clusters 5-9: severe, no-psychotic Clusters 10-17 (without 11): psychosis/functional

13

All contacts were face to face, non face to face contact were disregarded for this matching process

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Clusters 18-21: organic Demographics: Gender Marital status Ethnicity Age (using the groupings <18, 18-65, >65) Four levels of matching were used:

1. Match on all of the listed variables – 152 matched 2. Match on all of the listed variables except for ethnicity code – 21 matched 3. Match on all of the listed variables except for marital status code – 10 matched 4. Match on all of the listed variables except for ethnicity and marital status – 4 matched

After undergoing this matching process, 187 people were left from the Life Rooms cohort. The reasons for the reduction from 331 to 187 were that many did not have clinical activity within the required time periods or their patter of activity was so diverse that there was not an appropriate match. Two cohorts of 187 were therefore finalised (a Life Rooms cohort and non-Life Rooms cohort)

Appendix 2 – Focus group topic guide

1. Journey to Life Rooms

What was this? Was Mersey Care a part of this?

2. Expectations and first impressions

Preconceived ideas and first impressions How does LR compare to other services that you have used? Is there a difference?

3. Experience and impact

What have you accessed at LR? - Recovery College/Pathways Advisors/Peer Support/Café/Social aspect

What was that like? People/Environment/Service Anything that was helpful or useful about LR?

- Benefits of social inclusion vs. actual services accessed at LR

Any wider impact of LR? e.g. family/relationships; life challenges; resilience Where are you now?

- Personal growth/development/self-awareness/stigma

*Use of cards listing words from previous qualitative findings – do any of these words resonate with you?*

4. What’s next?

Quantitative: Involvement with clinical teams in the future

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Qualitative: How might your recovery progress and move forward? Hopes, dreams and goals. Has LR led you onto further things?

5. Feedback

What would you change? Any improvements or suggestions?

Appendix 3 – Consent and participant information forms Consent form Title of the project: Evaluating the impact of the Life Rooms on the recovery of Mersey Care service users Version number and date: Version 5 24.04.18 Please place your initial in the box: 1. I have read and understood the information sheet for the above evaluation (Version

5 24.04.18). I have had a chance to think through this information, ask questions, and have my questions answered.

2. I understand that taking part is voluntary and that I can stop taking part at any time, without my care or legal rights being affected.

3. I understand and agree that once I submit my data it will become anonymised and I

will therefore no longer be able to withdraw my data. 4. I understand and agree that my contributions will be audio recorded and I am aware

of and consent for these recordings to be used for the purposes of this study. 5. I agree to take part in the above study.

________________________ __________ ______________________

Participant name Date Signature

________________________ __________ ______________________

Name of person taking consent Date Signature

________________________ __________ ______________________

Researcher Date Signature

Principal Investigator:

Clare Rotheram The Life Rooms, Evered Avenue, Walton, L9 2AF

01514786556 Clare.rotheram@merseycare.nhs.uk

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Information sheet

1. Title of the project

Evaluating the impact of the Life Rooms on the recovery of Mersey Care service users

2. Version number and date

Version 5 24.04.18

3. Invitation paragraph

You are being invited to take part in an evaluation of the Life Rooms. Before you decide whether to take part, it is important for you to understand why the evaluation work is being done and what it will involve. Please take time to read the following information carefully and feel free to ask us if you would like more information or if there is anything that you do not understand. Please also feel free to discuss this with your friends, relatives and GP if you wish. We would like to stress that you do not have to take part in this evaluation work, only take part if you want to.

4. What is this study about?

This study is to find out whether Mersey Care service users feel that the Life Rooms has had impact on their recovery. Recovery can mean different things to different people. In this context, it can refer to anything relating to individual wellbeing. We will be running some informal discussion groups to talk about your experience at the Life Rooms. 5. Why have I been chosen to take part?

You have been chosen to take part because you used the Life Rooms service between April – September 2017 and you have identified as a Mersey Care service user. 6. Do I have to take part?

Taking part in this study is completely voluntary and there is no pressure to be involved. You can decide not to take part at any time, just let us know. This will not affect your use of the Life Rooms in any way.

7. What will happen if I take part?

If you decide to take part in this study, you will be asked to take part in an informal discussion group. The groups will be small (6-8 people). They will take place in Walton Life Rooms or Southport Life Rooms. We will discuss experiences of the Life Rooms. There is no pressure to say anything if you don’t feel comfortable; say as much or as little as you feel comfortable with.

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The discussions should last about 1.5 hours. The groups will be facilitated by Life Rooms staff and service users together. This study has been designed and will be conducted by staff and users working side by side with support of the Collaboration for Leadership in Applied Health Research and Care North West Coast (CLAHRC NWC). The discussion groups will be recorded (sound only) so that we can make sure we capture all the contributions made. There will also be a note taker on the day. However, when making reference to particular contributions, we will not use your name. 8. Expenses and / or payments

Refreshments will be provided at the discussion groups. If you need support with travel expenses, let us know and we can try to help. 9. Are there any risks in taking part?

The discussion groups will encourage you to reflect on how the Life Rooms has impacted you. There is a chance that some people may become distressed through reflecting on difficult parts of their life. If this occurs, there will be a dedicated member of the team available for support. 10. Are there any benefits in taking part?

The benefit to taking part in this study is the opportunity to contribute to the development of the Life Rooms service. All participants will be provided with refreshments. 11. What if I am unhappy or if there is a problem?

If you are unhappy, or there is a problem, please feel free to let us know by contacting: Clare Rotheram on 01514786556 or clare.rotheram@merseycare.nhs.uk Alternatively, you can contact Mersey Care Patient Advice and Liaison Service (PALS) on 01514712377 or PALS@merseycare.nhs.uk 12. Will my participation be kept confidential?

The data we collect will be audio recordings of the informal group discussion. We will also take notes during the discussions. These recordings will be confidentially destroyed after transcription. This written data will then be stored electronically; no participant names will be stored with the data. The evaluation team will have access to the data. Other authorised staff will have access to this data only if they agree to keep it confidential (for example, staff who may write up the focus groups). Any quotes used in future publications or presentations will be fully anonymised. Any identifiable data from people taking part will be destroyed in a confidential manner after a three year period.

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13. What will happen to the results of the study?

The final report from this study will be made available to the Trust, relevant external agencies and any participants who have requested a copy. You will not be identifiable in the report unless you have consented to being so. 14. What will happen if I want to stop taking part?

You can stop taking part in this study at any time, without explanation. Your contribution up to this time may be used, if you are happy for us to do so. 15. Disclosure Barring Service check (DBS)

The staff and volunteers involved in this study have obtained a DBS check and you may request evidence of the DBS from the Principal Investigator. If you have any further questions, please contact: Clare Rotheram The Life Rooms Evered Avenue Walton L9 2AF 01514786556 Clare.rotheram@merseycare.nhs.uk

Appendix 4 – Theme frequency information

Theme(s) Frequency

ACCESS - Accessibility – public transport, all on one level

- Referral

o MCT practitioners o Non-MCT practitioners

- Expectations o anxiety/scared/hesitant/nervous about coming

17 19 12 19 24

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LR VIBES - LR people – welcoming, friendly, available

o Feeling heard/valued/respected o Feeling understood

- Environment – light, open, space, airy o Differences between venues

- Atmosphere – relaxed, calming - Good first impression - Place to just „be‟/use of space - Not a „normal‟ service - Community - Safe space

90 22 23 65 10 53 27 11+3=14 39 10 14

LR ESSENCE - Belonging - No pressure/own pace - Shared experiences

o learning from each other o telling your story o being honest about how you feel o supporting each other o empowering each other o familiarity o collaboration o peer support occurs organically within context of LR

- Value of lived experience – increases learning, inspiring. - Access to opportunities – LR provides context/environment

for choice, in terms of both attending and what is accessed. o Access to learning/courses o Access to practical

support/advice/guidance/information o Access to resources o Access to LRSWs

- Normalising o Not judged, no stigma, no labels.

- Challenging medical perspective o Previous bad experiences

11 24 51 12 21 8 5 1 5 31 30 32 16 5 1 35 50 5 38

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IMPACT - Individual

o Building skills coping strategies, managing and understanding

condition learning to look after self being able to assert/ask for what you need,

communicating feelings challenging self

o Social inclusion building/improved/stable relationships networking/finding out about other opportunities

from people at LR. Reduced isolation

o Pride/Esteem o Worth/Value o Feeling better

change of perspective o Routine/Structure o Reflecting on how things were before o Self-awareness/knowing self o Self-empowerment/self-motivation o Inspired by others o Strengthening identity

defining self in own terms – links to challenging medical perspective?

o Developing hobbies/interests o Hope for the future o Progress:

Practical steps e.g. public transport/shopping/washing and dressing/gaining independence

Individual level e.g. sitting further from the door Outcomes –

volunteering/employment/discharge from clinical services etc.

- Beyond the individual o Support for carers/family o Knock on/ripple effect

- Used in combination with clinical care o Pathways out of clinical support

58 28 25 2 6 9 70 30 7 5 30 23 28 10 21 30 47 7 10 3 3 5 78 8/2 11 26 15 3 5

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NEXT STEPS - Goals:

o Moving out of clinical support o Employment o Coming off benefits o Coming off medication o Volunteering o Continuing with LR opportunities o Physical health o Pursuing hobbies/interests o Exploring further opportunities

- Worried/hesitant about taking next steps – recognition of this links to knowing self; also links to initial feelings of hesitancy/worry upon accessing LR.

18 1 13 3 3 6 4 2 3 8 5

FEEDBACK/AREAS FOR IMPROVEMENT - Café: cheaper facilities - Follow on courses/less formal social groups – maintain

friendships and skills through socialising - Improved integration with other services e.g. GPs/council - Recovery College processes - Proactivity – could we contact people and ask whether they

want to come in? - Promotion/Public Awareness of LR

o SU involvement - Partnership Developments - Outdoor opportunities - Story sharing with clinicians - Extended opening hours

7 2 7 11 6 7 14 3 2 1 1 4