From Chelsea Feel Good Garden to social prescribing: how ...€¦ · Social prescribing helps calm...

From Chelsea Feel Good Garden to social prescribing: how do we

broaden our offer for mental health and wellbeing?

EXPO18: 5 September 12.15 - 13.45

James Sanderson

NHS England

Director of Personalised Care

“Social prescribing connects people for wellbeing”NHS England priorities

Referrals: GPs and other agencies, self

referral

SP Connector Scheme: employs

‘link workers’

Community groups & services

1. We will support the commissioning of local SP community connector

schemes as part of our personalised care approach.

2. We will support mental health trusts to connect people to community

groups.

3. This depends on partnership working, sustainable local voluntary

organisations and community groups.

4. Support offer includes regional SP networks, online collaboration,

Common Outcomes Framework, mapping existing schemes, personalised

care demonstrator sites and support for mental health trusts.

www.england.nhs.uk

Feedback from Chelsea May 18

What participants told us they wanted:

• A network

• Research (being more specific about how, where, what and

what works best)

• Help to convince other people

• Ways to connect with organisations around you

www.england.nhs.uk

Mental health, recovery and social

prescribing: swimming in calmer waters

Jo PainterNurse Consultant , Adult Mental Health, RDASH

Nurse Lecturer (MH) – Sheffield Hallam University

Mental health service deliveryTreatment – intervention - recovery

The recovery dilemma

Rough seas....

The treatment dilemma

Rough seas ....

Social prescribing helps calm the water …

• Increasing social activity - improving quality of life

• Reducing social isolation and dependence

• Improved partnerships

• Functional relationships and peer support

• Investing in life after services • Making recovery sustainable

Investment in Communities

Creation of Capacity

Quality of Life

• https://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/eval-rotherham-mental-health-social-prescribing.pdf

• https://www.youtube.com/watch?v=GMSGYet7SB8&feature=youtu.be

Social Prescribing in Mental Health Services

Phil Walters and Debs Taylor

Background & key themes

Developing creative activities that support wellbeing

Listening to people & coproduction: activities that people want

Mission: people living well in their community & reaching their potential

Broad definition of creativity: promoting greater choice

Passion and soul: restoring hope, meaning & purpose

Partnerships & match funding: working with communities

Non-medical, non-judgemental: warmth & compassion

Empowerment: peer support and peer-led projects

Social movement: people got behind it!

How people used to find their soul food

Our communities have a long and rich history

of using arts, sport and other leisure activities

to enhance their lives.

Evidence

People’s stories

People’s talents\assets

Evaluation\feedback

Warwick & Edinburgh Mental Wellbeing Scale

Social return on investment

Participatory research

Deb’s story

• First had issues when I was 8 years old

• I had mental ill health all my adult life

• Never been creative

• Creative Minds changed my life

• Swapped pills for paint

• Feel empowered to control my illness

• I HAVE a life!

Contact us

Web: Creativemindsuk.com

E-mail: Creativeminds@swyt.nhs.ukTweet:@Creat1ve_M1nds

Facebook: Creat1ve.M1ndsCall: 01924 327567

Partnership Gardening Project between Scarborough Survivors and Tees, Esk and Wear Valleys NHS FT

Caroline Strathearn, Occupational Therapist

Debi Smalley, Occupational Therapy Assistant

Where it all started

How it’s developed

Where it’s at now

“To plant a garden is to believe in tomorrow”

We believe we are:

Enabling individuals with lived experience of mental ill health to develop social connections that can support transition out of hospital

Working together on a common goal to reduce barriers towards mental health care and lessen anxieties about an inpatient stay should one be required

Encouraging prolonged engagement with a support service outside of secondary care

Promoting vocational skill development, purpose, sense of worth, responsibility and increasing social skills

Valuing the role of nature-based therapy on an individual’s recovery

Where are we going?• As a partnership we are able to apply for grants and funding to further

support the project: currently looking towards a grant for a poly-tunnel to expand the amount of gardening we can offer year round, thereby cultivating many more crops

• Harvesting the produce to use in cooking groups

• Expanding due to popularity, developing more green spaces as a community

• Sharing resources across the trust, expanding the initiative across TEWV to improve individuals’ recovery outcomes in other areas and services

• Building links and sharing learning with other organisations/groups across UK

• Research into benefits of the partnership, including testimonies from members

@ExpoNHS #Expo18NHS

Contact Details:

caroline.strathearn@nhs.net

@CarolineStrath

Thank you

Dr Rachel Bragg

Development Coordinator, Social Farms and Gardens;

Green Exercise Research TeamUniversity of Essex

A new ‘offer’ in mental health: care farming and the nature, health & wellbeing sector

Increasing interest in using nature for mental health

• So many different ‘nature- based’ initiatives now

• Being run by and for many different people

• Sometimes difficult to navigate to find service required

• Nature, health and wellbeing sector: has started to unify and to deliver a clear message to health and social care commissioners to aid this

Evidence and demand

• Strong evidence of the efficacy of nature-based interventions in addressing health & social care issues (Bragg and Atkins, 2016).

• Growing demand and appetite for green care services from beneficiaries; an increasing interest in referring to these types of services from commissioners (Mind, 2013; Bragg et al., 2015).

• Need to look at referral mechanisms / opportunities

• Social prescribing – a solution??

Natural surroundings

Psychological restorationReduced stressAttentional capacitySense of calm and safety

Meaningful activities

New skillsSense of achievementResponsibility Confidence

Social

contextPart of a groupSocial contactInclusionSense of belonging

Green Care

STH, ECI, Care Farming

STH – Social and Therapeutic Horticulture; ECI – Environmental Conservation Interventions; Source: Bragg and Atkins, 2016

Benefits come from the interaction of three key elements

The Nature, Health and Wellbeing Sector

Green CareCare Farming;

Horticultural Therapy & STH;Environmental conservation

therapy; Animal Assisted Therapy;Nature therapy;

Green exercise therapySource: Adapted from Bragg and Leck, 2017; and Thrive, 2017

Green Care(Nature-based therapy &

care interventions)Therapeutic interventions -

Special populations

Nature-based community health promotion

Health promotion - Particular populations

Nature in everyday lifePrimary prevention - General

population

Everyday natureFarming;

Forestry; Gardening; Horticulture; Green exercise; Animal based

recreation

Nature-based health promotion

Community farming;Social and Therapeutic

Horticulture (STH); Community food growing;

Community gardening; Green exercise

The Nature, Health and Wellbeing Sector

Source: Adapted from Bragg and Leck, 2017; and Thrive, 2017

Green Care(Nature-based therapy &

care interventions)Therapeutic interventions

- Special populations

Nature-based health promotionHealth promotion - Particular

populations

Nature in everyday lifePrimary prevention - General

population

Needs of the individual: More acute

Less acute

Health & social care interventions

Public health initiatives

Public health messaging

Multiple delivery options

• Many organisations deliver both types of service…….

• Commissioned referrals for individuals with a defined need as part of a care/therapy programme

• More generalised, less formal approach, for groups, one off visits, ‘volunteering’, drop-in, community resource etc.

• Often very different referral mechanisms, funding, costs and support needs for the two approaches

• Need to be clear which service i) is required by commissioner; and ii) is being delivered

“Care farming is the therapeutic use of farming practices”

Care farms:

• Deliver health, social or specialist educational care services for one or a range of vulnerable groups of people.

• Provide a programme of farming-related activities for individuals with a defined need

• Provide supervised, structured care services on a regular basis for service users

• Are commissioned to provide services by a range of referral agencies

• Care farming is a form of Green Care43

Emphasis on quality

Care farming Code of Practice• A set of guidelines / minimum standards

• Developed by care farmers and other specialists

• Self-assessment with appraisal by Panel of experts

• Great feedback and acceptance from a variety of different commissioners, Government and client groups

• Some ‘peace of mind’ and assurance of high quality service provision

• The more farms that sign up, the more credible our sector as a quality, professional service

Multiple outcomes from green care

o Still a need to raise awareness – commissioners practitioners, service users, general public alike

o Multiple outcomes

o simultaneously produces positive life outcomes

o wider than clinical outcomes

o integrates health and social care

o is therefore cost-effective

o also enjoyable, good adherence – people go back!

o Ticks many of the boxes for health and social care policy (and specialist education, probation etc)

o Ideal for social prescribing and for OT

The Future – exciting times!

Source: Adapted from Bragg and Leck, 2017; and Thrive, 2017

Green Care(Nature-based therapy &

care interventions)

Therapeutic interventions - Special populations

Nature-based community health promotion

Health promotion - Particular populations

Nature in everyday lifePrimary prevention - General

population

Dr Rachel Bragg

Social Farms & Gardens

Email: rachel@farmgarden.org.uk

Tel: 0300 600 0290

Dr James Szymankiewicz

Chair Devon Local Nature Partnership

Vice Chair North Devon GP Collaborative Board

Chair Plastic Free North Devon

A Dose Of Nature

Our Mental Health, Our Wellbeing

and Our Natural World

Current health of the nation(could be better!)

• 62% adult population overweight or obese

• 35% children ages 2-15 overweight

• Lifestyle illness costs the NHS at least £15 billion a year

• 1990 – 9 million prescriptions for antidepressants a year

• 2016 – 65 million: Cost of £266 million

• 1 in 4 of our adult population experience a mental health problem each year

• Over the last 25 years rates of depression and anxiety in teenagers has increased by 70%

• Cost of mental health to UK economy £105 billion/year

What we are doing currently is not working

Current state of the environment (could be better!)

The disconnect that exists between us and nature is bad for our health and the health of the environment

Nature-based interventions can help address this. They have benefits for physical and mental health,

and can be designed to be both preventive and therapeutic.

Targeted nature based interventions have demonstrated efficacy and cost effectiveness in the management of…..

• Depression, anxiety and addiction • Slowing progression of Dementia • Chronic diseases• Isolation and loneliness

Evidence!

What does that mean?

The vision

• At a local and national level the dependence of human health on healthy ecosystem services is recognised and embedded in strategy.

• The value and role of nature-based interventions is recognised and embedded.

• Opportunities are available for all ages and social demographic

• The critical importance of engaging children is recognised and resourced eg forest schools.

• We create a legacy for this work

What do we need? • Top down

• Clear cross department message.

• Embed chapter 3 25 YEP in DoH strategy

• Bottom up

• Partnerships with shared values

• Passion and vision

• Challenge status quo

• Funding

• New approach!!

• Opportunities for placed based care and budgets

What are we doing in Devon?• Strategy

• Partnerships

• Charter

• Place based approach

• Delivery

• Naturally Healthy Delivery Team (LNP)

• Wellbeing - Green Infrastructure

• Therapeutic • Not a one size fits all model

• Looking at coordination/sustainability – role of social prescribing

Our Projects Devon Citizen Project

• Partnership DCC, CCG, voluntary sector

• £10 million social prescribing project through Life Chances Fund – Big Lottery

• Focus on carers, those with 2 or more LTC, socially isolated. (Needs Identified through JSNA)

• Involves and builds on successful social prescribing projects in Devon

• Community connector model

• Intention is to have some of the interventions available as “green prescriptions”

Our ProjectsConnecting Actively with Nature (CAN).

• Partnership project with LNP+Active Devon

• Connect 3000 over 55s with nature to benefit health

• £750k funding from National lottery and Sport England

There is robust evidence that naturally healthy interventions are cost effective and work

We need to mobilise top down bottom up support to change a culture

Thank you for listeningQuestions?

Thank you for listening

Jennifer Layton: my story

Table top discussion

How can NHS England and partners support mental health trusts to expand their service offer to include social prescribing?