ANNUAL GENERAL MEETING AND DISCUSSION ON
‘ON THE EDGE’ PROJECT – OCTOBER 23RD 2007 – COMMITTEE ROOM 5
Present:
Lynne Jones MP
Timothy Loughton MP
Sandra Gidley MP
Ann Milton MP
Nick Harvey MP
Tim Boswell MP
Ian Hall – Royal College of
Psychiatrists
Neil Balmer – Royal College of Psychiatrists
David Foreman – Royal College of Psychiatrists
Rebecca Hutchinson – Jansen-Cilag Ltd
Trish Shepherd – Jansen-Cilag Ltd
Jonathan Coe – Witness Against Abuse
Helen Dupays – Prince’s Trust
Melian Mansfield – CASE (Campaign for State Education)=
John Metcalfe - BASW
INTRODUCTIONS
AND AGM
Lynne
Jones,
chairing, welcomed everyone to the meeting and vacated the chair for the election of the
Group’s officers for 2007/8.
The
following were elected:
Joint-Chairs:
Lynne
Jones MP
Sandra
Gidley MP
Timothy
Loughton MP
Secretary:
Baroness
Murphy
Lynne Jones outlined the proposed forthcoming topics for the meeting
and invited others to raise issues that they thought should be debated.
Jonathan
Coe, from Witness Against Abuse, raised the issue of boundary issues in mental health and
suggested that it would be good to have a follow up meeting to assess what has happened
since recent Government responses to the Kerr/Haslam Inquiry.
PRESENTATION ON ‘ON THE EDGE’
Lynne
Jones introduced the ‘On the Edge’ project team:
Dr Glenn Roberts, Consultant
psychiatrist
Mr
Keith Portlock, Chair Devon Partnership NHS Trust, and Chair of the OtE: Devon steering
group
Yvette Denham, Lead North
Devon Early Intervention Service
Richard
Feltham, Project worker On the Edge: Devon
Mr
Keith Portlock gave an introduction to the
presentation. He described that the project had won national & local awards and it was
their ambition to recreate the programme to be available for all 15 year olds in Devon
schools.
Dr Glenn Roberts gave a slide-show presentation to the meeting.
He began by giving a
background to the project, which he said had started as action research, and their
ambition is to turn it in to a health education service.
He described how the project
is the largest and best evaluated health education programme on severe mental illness
(psychosis) for schools in the UK. It has won many awards, including winning at the NIMHE
Positive Practices Awards for Child and Adolescent Mental Health Services 2005 and the
Health and Social Care Awards 2005 (South Region).
This programme contributes to
fulfilling a number of governmental and service development targets, notable National
Service Framework (1999) standard 1 Mental Health Promotion, the Policy Implementation
Guide on Early Psychosis Services (DoH 2001), and the International Early Psychosis
Declaration (2004). All of these underline the need for health education for young people.
Dr Roberts outlined the
background to early intervention services and explained that the key to successful
intervention is engaging people early. ‘On the Edge’ he said, is a unique
project which aims to support early engagement through education based on interactive
drama.
It was initiated by an
advisory group made up of people with direct experience of psychosis (i.e. service users,
carers, and staff at Early Intervention (EI) services).
The group agreed three main
aims:
1) To increase knowledge and understanding
2)
To reduce stigma
and discrimination; and
3)
To support help-seeking and
show people where to turn and how.
The project is aimed at young people aged between 16 and 25 in
schools and colleges and those who care for them: counsellors, youth leaders, community
police, and GPs. However, it also looks to help those who will be providing new services
for young people, and new EI teams.
Dr Roberts explained that the
drama portrays a lot of information about psychosis, but that this alone is by no means
enough to get people engaged. He said the value of interactive drama was in connecting
with young people at an emotional level so they identified with the characters and the
events, cared about what was happening and what would happen next. The programme was also
structured over three weeks to create a prolonged attachment and thoughtfulness by living
with the unfolding story over time.
Merging health and education
in the project worked as a bridge to cultivate understanding and also a means of
connecting local health and educational services. They use applied drama as a form of
social intervention to gather stories from the people who live them, represent them to
others, and ultimately interweave them.
A lot of organisations joined
together in enthusiasm about this project, including Rethink, the Royal College of
Psychiatrists, Young Minds and MIND.
What they did?
He showed that between December 2003 and March 2005, there were 124 performances.
The programme is delivered in
3 phases: Provocation, Exploration and Consolidation.
Provocation: A week before the
performance, in a 25 minute session, the teacher uses a pre pack which draws participants
into Terry’s story and prepares them for the theatre company’s visit the
artifacts used for this lesson then appear as props in the play.
Exploration: A visit by the
theatre company. This includes a 40 minute performance in which students see a young man,
his family and friends struggle with his emerging mental health problems. A number of
interactive approaches allows audience members to question people in the story and to
decide what needs to happen to help Terry. (90 minutes)
Consolidation: A follow up phase
on a later day. A Professional Health Education worker led session that is flexible to
involve school councillors and local mental health staff, and invite students to reflect
on what they have experienced, make more sense of it and explore what could help and where
help is available.
Evaluation:
Extensive qualitative and
quantitative evaluation was embedded in the programme from the outset conducted by
researchers (Rowena Passey and Dr Jos Dawe) who were not involved with delivery of the
programme. This involved analysing responses from nearly 2000 students making this largest and most
extensively evaluated project of its type in the UK to date.
This evaluation, Dr Roberts
said, showed that they achieved what they
set out to do with significant gains against each of the 3 aims of the project –
there was also significant learning about how such a programme could be redeveloped and
improved.
There is considerable evidence
in support of On the Edge in delivering positive results in all 3 key health promotion
dimensions (Sainsbury Centre, 2004) i.e:
·
Strengthening individuals by;
enabling conversation and exploration of mental health problems, breaking the taboo,
conveying key information, and opening doors to help.
·
Strengthening communities by;
promoting ‘mental health literacy’ within the school environment, and engaging
students and their teachers in an acceptable and memorable health education experience
together.
·
Reducing structural barriers to
mental health by; connecting teaching staff with mental health workers and organisations,
and signposting available sources of local help.
What to and where next?
The next cycle of the project
is to reach every 15 year old in Devon schools starting in the Autumn of 2009. They aim to do this by developing a bid for lottery or
other grant funding
This would be for a 3 year
health education programme, based on ‘On the Edge’, which would be a mental
health education service, research base and a national model for early intervention.
Dr Roberts pointed out that
there are very few programmes like ‘On the Edge’ which have the evidence base to
make a difference and it continues to have considerable support and endorsement from
national and international leads.
They have set up an
independent charity, On the Edge: Devon to develop bids and manage the programme if
successful with a steering group, chaired by Keith Portlock and a project worker Richard
Feltham.
With 100% support from Devon
Early Intervention services and workers and nation support from the National Director for
Mental Health, and the President of the Royal College of Psychiatrists, they want to take
this forward and achieve their aim both in Devon, but with continued evaluation, learning
and teaching, to be a means of contributing to the ongoing national debate about
meaningful and effective mental health education and health promotion.
Lynne Jones MP then opened the discussion to the
floor.
Tim Boswell MP started
the discussion off by praising the presentation and the ‘On The Edge’ project
and stated that he believes there everybody is signed up to the basic approach of
intervening early.
He started by asking whether
the referral system was open to peers/parents. Dr Roberts responded to this by
saying that the referral system was no hurdle at all; early intervention is open to all
referrals.
Mr Boswell then focused on
the issue of whether there is a danger of the show leading to people inventing a mental
illness. Ms Denham said that there maybe examples of this, but it is unlikely.
Anne Milton MP
also expressed her thanks to the ‘On the Edge’ team and said that she thought it
was a very good presentation. She said that the issue of stigma was terribly important and
that it was good that this presentation dealt with it. Her question related to the
definitions of psychosis. She asked how tight the definitions are and are there people who
are very ill but do not have the diagnosable psychosis but may head down that route later
in life.
Dr Roberts agreed that stigma was an extremely important issue
and pointed out that often a lot of people who suffer from mental health problems find the
stigma harder to deal with than coping with their actual mental illness. He then said that
an inherent goal of the early intervention services is to work in the best stigma-free
way.
Ms Denham – said
that that the issue of definitions of psychosis was not a problem because they offer a 3
month assessment period. Early intervention services make a virtue of being able to work
with people where there appears to be a significant risk of severe mental illness but
diagnosis remains unclear – this is in marked contrast with old ways of working when
it was felt better to ‘wait and see’ and only intervene when diagnosis was
clear.
Anne Milton MP then asked what involved they have with the police.
Mr Portlock (who is a
retired senior police officer) replied and said that the Anti-Stigma Training and
Evaluation Collaboration (ASTEC) project has
done a lot of work with the police and involves them in the process.
Tim Loughton MP asked
about the Black and Minority Ethnic perspective and whether there was any evidence that
this appeals to BME communities, who are notoriously hard to reach. He asked if this
medium (the ‘On the Edge’ project) was more or less successful at dealing with
mental health problems in the BME communities.
Dr Roberts replied
that with ‘On the Edge’ being a project based in Devon, even though the area has
a low percentage of ethnic minorities it did include an Asian character. If this project
was rolled out across the country then it would be able to be performed in much more
ethnically diverse areas with more ethnic minority involvement. When on national tour it
performed to very ethnically diverse audiences at Chalk Farm in London with considerable
success.
In terms of whether it is
more or less successful, Dr Roberts said that they really didn’t know for
sure. However, applied arts projects like ‘On the Edge’ are very good at
attuning to cultural settings. So, if it was rolled out then it would have the potential
to have an impact.
Sandra Gidley MP asked
two different questions. One was on the gender variations with the projects and the other
was whether the project had produced any benefits that they had not expected.
On the second point, Dr
Roberts said that one of the big unexpected benefits was the number of people who came
forward for current mental health problems. The Wellcome Trust had guided the programme to
have a qualified mental health practitioner touring with the company to respond to people
that came forward straight after watching the show and also connect them with their local
services.
In terms of gender
differences, Dr Roberts said that there was no clear evidence about whether it
worked better for one gender over another. However, there were gender differences in terms
of identification with characters.
Lynne Jones MP
asked if the project focused on cannabis use and the link between it and psychosis.
Ms Denham said that
they had decided not to cover cannabis as they did not want to give the impression that
only young people who smoke skunk have psychological problems.
Dr Roberts added that
cannabis, and drug use more generally, were common issues that came out of the
discussions; but the project wanted to look at the whole picture and therefore didn’t
focus on drug use.
Discussing a question on
whether the project would save money, Dr Roberts said that it would be hard to
fathom exactly how much, but that it would seem that there should be significant cost
savings.
Ms Denham said that
research from the Institute of Psychiatry had shown that early intervention is cheaper
that treating.
Responding to a question on
whether this type of programme could be used for people who are already in early stages of
psychosis, Ms Denham said that there were already other tools available to deal
with the early stages. ‘On the Edge’ is designed to engage young people in
considering the issues before they occur and can be used to support cultural change
towards greater knowledge and understanding in schools and colleges. It was created with
support from young people who had experienced psychosis but its focus is in support of
first contact and preventive measures.
Dr Ian Hall, from the Royal College of Psychiatrists, asked what
the reaction from teachers had been, and whether the project team had tried to get it
mapped in to the school curriculum.
Dr Roberts said that
the project already fulfils PHSE targets, so it can be a means for those ends. It has been
used for PHSE teacher training and has also been recruited by the ASTEC project as a
vehicle for student teacher education in 2008/9.
Tim Loughton MP pointed
out that the Department of Children, Schools, and Families has the responsibility for
Child and Adolescent Mental Health Services, so perhaps a route in is through school
nurses.
Lynne Jones MP added that there is a danger in
overloading teachers with too much information, and some times even very willing teachers
could feel out of depth.
Helen Dupays from the
Prince’s Trust asked about whether the project could be transferred to people out of
school.
Dr Roberts said that
the difficulty with this is the point of contact and how you can find the people to engage
with. There are other alternative social venues where conceivably it be considered in.
John Metcalfe from BASW asked whether the ‘On the Edge’
project had engaged with social workers. The ‘On the Edge’ team each responded
by saying that social workers were quite rare in the South West, but they know that some
social workers did watch the play.
One problem for the social
work profession at present, pointed out by Dr Roberts, was that mental health social
workers tend to be quite compromised in their therapeutic practice and largely tied to
rotas in relation to their statutory duties. However, they are a valuable group with the
potential of linking with families and communities.
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