Happiness Project

Light box
The Happiness Project
Evaluation Report
Written by Lucy Duggan, Lucy Barfoot and Kathryn john
October 2011
T his ev aluation w as undert ak en by light box, adv ised by t he w illis new son/
uw e k now ledge t r ansf er p art ner s hip
Drawing tops used in the Vitality 2: Movement workshop
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Contents
1. Introduction
P age
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2. Background
2.1. Description of the project 2.2. Positive Psychology foundation 2.3. Project team 2.4. Rationale for the project 2.5. Pilot project 2.6. Funding and finance 5 6 7 8
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3. People
3.1. Stakeholders 3.2. Partnerships 3.3. Volunteers 3.4. Participants 13 14
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16 4. Project evaluation
4.1. Background 4.2. Rationale 4.3. Approach (Internal evaluation) 4.4. Project aims 4.5. Data collection methods (to include appreciative inquiries and steering groups) 4.6. Data analysis 4.7. Results 4.8. Discussion ( to include achievement of aims; observations; steering group influence; sustainability and future financial considerations) 4.9. Recommendations 18 19 20 21 22 24 25 39 41 5. The Happiness Project: next instalment
5.1. Autumn Workshops 5.2. On from Autumn 43 44 6. Conclusion
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7. References
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8. Appendices
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1. Introduction
This is a report on the Light Box Happiness project. It describes the rationale for the project, identifies key stakeholders, and presents the findings of the project evaluation. The report was written by Lucy Duggan, Lucy Barfoot a nd Kathryn John of Light Box. We are grateful for the training and mentoring provided b y Meg Attwood and Professor Norma Daykin through the Willis Newson/ UWE Knowledge Transfer Partnership (KTP). 3
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Background
The Gratitude Tree in THE LIGHT BOX SHOP IN THE GALLERIES, BROADMEAD. 4
2.1 Description of the project
Light Box is a Community Interest Company, that provides ‘Happiness Workshops’ for the wider Bristol community. These two-­‐hour workshops are free to attend. They invite participants to examine 10 themes that are connected to the promotion of mental well-­‐being: Gratitude / Goals / Appreciation of Beauty / Savouring and F low / Confidence / C haracter Strengths / Nurture and Kindness / Humour and Playfulness / Vitality 1: Food and Mood / Vitality 2: Movement In each of the 10 workshops, facilitators present research findings that relate to well-­‐being. During the group discussions and creative art activities that follow, participants generate ideas for Recommended Actions that they are encouraged to implement into their daily lives. They a lso create an object to b e used as a visual reminder to engage in actions that promote their well-­‐being. The Happiness Workshops are d esigned to reduce the stigma associated with mental h ealth issues, increase resilience, and to help p eople make tangible improvements to their lives. Rather than focusing on illness, The Happiness Project presents mental h ealth in a p ositive light: as an exciting, empowering social phenomenon a nd on a continuum on which we are a ll placed. Between April 1st and June 30th 2011, 51 workshops and two 10-­‐week courses were h eld in Light Box’s shop, located in The Galleries in Broadmead, Bristol. Workshop timetables are included as Appendix A. \
“How refreshing to come a cross a p lace like this. An oasis in a busy world. May it prosper and many weary p eople come through its doors to b e refreshed in body, mind and spirit.” Participant 5
2.2 Positive Psychology foundation
The evidence base for positive psychology informs much of the workshop’s content. Light Box has received informal consultancy from University of East London Master’s graduates in Applied Positive Psychology, Cassie Robinson and Lucy Ryan. Direct guidance a nd encouragement were a lso provided b y Acacia Parks and Martin Seligman; both positive psychologists from the University of Pennsylvania, and Tal Ben Shahar who lectures in applied p ositive psychology at Harvard University. Positive psychology is a branch of psychology that emerged in the 1990s. Its purpose was summed up in 1998 by Martin S eligman and Mihaly Csikszentmihalyi. "We believe that a psychology of positive human functioning will arise, which achieves a scientific understanding and effective interventions to build thriving in individuals, families, and communities." (Seligman & Csikszentmihalyi. 2000, p.5) Positive psychologists seek "to m ake normal life more fulfilling", n ot s imply to treat mental illness (Compton, 2005, p.19). The field is intended to complement, not to replace traditional psychology. It has a p ositive focus, emphasising the importance of understanding the d eterminants of well-­‐being rather than the causes of mental illness. /
“Thank you for the workshops. Coming to them has made a big d ifference. I don’t take life as s eriously now a nd I feel much b etter for it.” Participant 6
2.3 The project team
The project is run b y a s taff team of three, who are supported b y a group of n ineteen volunteers. Lucy Duggan and Lucy Barfoot co-­‐founded Light Box in April 2009. Lucy Duggan is responsible for Project Development a nd a workshop facilitator. She received a 2:1 in Sociology and Politics from the University of Bristol in 2003. She has since obtained an OCN level 3 a ward in Creativity in Social Care in 2009 and b een a warded a level 5 in Social Enterprise Leadership from Plymouth University in 2011. Lucy is a practising artist and has lived experience of bipolar d isorder and recovery. Lucy Barfoot is Light Box’s Creative Director and a workshop facilitator. She received a 2:1 Bachelor of Fine Arts degree from the University College for the Creative Arts in 2008. Lucy is a practising artist, holds a creative interest in sculpture installation exploring themes of vulnerability, ephemerality a nd economy. She has wide experience of facilitating public art workshops. Kathryn John is the project’s Volunteer and Project Coordinator and a workshop facilitator. She graduated from Aberystwyth University in 2006 with a 2:1 in Art History. She achieved a Distinction grade Further Education PGCE at Cardiff University in 2008 and has worked as a teacher in a range of educational contexts. She is also a practicing artist. Kathryn began as a Light Box volunteer in 2009 and joined the staff and directing team in 2011. /
“I just wanted to say what you are doing h ere is a mazing. Good luck.” Participant 7
2.4 Rationale for the project
Mental health
Mental h ealth problems are extremely common: in Great Britain, 1 in 6 adults will have a mental health problem at any one time (Sainsbury Centre for Mental Health, 2003). Estimates put the full economic cost of poor mental health a t around £77 billion p er annum, mostly due to lost productivity (Sainsbury Centre for Mental Health, 2003). Good mental h ealth is fundamental to everyone’s quality of life; however there is limited public a wareness of the actions that support good mental h ealth and well-­‐being. National Context
Acti on f or Hap p i nes s
Action for happiness, a national initiative to promote investment in mental h ealth, was launched in 2011. This has raised the public profile of well-­‐being. No Healt h w it hout ment al healt h
The latest cross-­‐governmental mental h ealth strategy shifts the focus of s ervices towards promotion of mental health, prevention of mental illness, and early identification and intervention as soon as mental illness arises (HM Government, 2011). The strategy calls for the fostering of innovative practice, supporting research and ensuring the quality of evaluation. Art s and Healt h
The role of arts based activities in supporting h ealthcare d elivery and contributing to health outcomes is widely recognised (Cayton 2007; Department of Health with Arts Council England, 2007; Clift et al, 2009). A national study found s ignificant improvements in empowerment, mental h ealth and social inclusion following participation in arts activity, with greater improvements in empowerment and mental h ealth for participants with ‘clinically significant’ mental h ealth problems ( Secker et al, 2007). Local Context
NHS Bristol and Bristol City Council work in partnership to d evelop mental health strategies. Their priorities lie in the areas of strengthening positive mental h ealth promotion, tackling s tigma and d iscrimination and a lso improving access to psychological therapies. These are addressed b y the Local Implementation Team’s strategy ‘Vision for the Future’ ( Hunt and Lyle, 2008) and the ‘Promoting Positive Mental Health in Bristol S trategy, 2008 – 2011’ (Robertson, Gray and Bramley, 2008). 8
Vision f or t he F ut ur e
The key recommendations in the Local Implementation Team’s strategy include the following:  Services to b e integrated within mainstream facilities for increased a ccessibility and reduced exclusion  Focus to b e moved towards h ealth promotion, prevention and mental well-­‐being  Innovative solutions to b e used  A greater choice of s elf-­‐help resources and talking therapies to be made available The report a lso anticipates an increased role for voluntary s ector organisations as service providers: ‘We welcome partnerships with a range of organisations that can demonstrate to us that they are able to provide the type and quality of services we – and s ervice users -­‐ want to s ee. We expect that commissioners will routinely consider the voluntary s ector when planning new s ervices’ (Hunt and Lyle, 2008, p .31). Promoting P ositiv e Ment al Healt h in Brist ol St rategy, 2 008 - 20 11
This strategy supports the d evelopment and delivery of preventative interventions a nd positive mental h ealth promotion. Two key objectives are:  To raise a wareness of current research and good practice in mental h ealth promotion  To support the creation of a ‘mentally h ealthy’ city Social participation is h ighlighted in the report as a means of achieving these objectives, with particular mention being made of the role creativity and participation in the arts has to p lay in improving mental h ealth at community level. Project Aims
The aims of Light Box’s Happiness Workshops are closely a ligned to the national and local mental h ealth agenda:  Promoting mental h ealth  Preventing mental illness  Providing an early intervention facility  Supporting p eople with mental h ealth problems Light Box adheres to a person-­‐centered philosophy, as advocated b y humanist psychologist Carl Rogers. It understands participants to have ‘self actualizing tendency’ -­‐ an innate d esire and ability to improve their well-­‐
being. As such, the creation of a safe, relaxing and respectful space is paramount, engendering a n atmosphere of trust, empathy and unconditional positive regard. The Light Box premises are centrally located, accessible and visually appealing; this provides an a tmosphere conducive to relaxation, trust and the fostering of positive relationships. The project aims to champion inclusion, with workshops suitable for participants of diverse backgrounds, a ges and abilities. It a lso s eeks to tackle stigma b y addressing mental h ealth a way from clinical s ettings. In this way, it provides an appropriate facility for prevention and early intervention. 9
2.5 Pilot project
In March 2010, 282 members of the public participated in 44 p ilot, open-­‐access, workshops of the Happiness Project in a former shop on Union Street, Broadmead, Bristol. Internal evaluation of the pilot showed a positive response to the workshops, with case studies reporting tangible improvements in well-­‐being following participation. For a project report on the pilot s ee: http://wearelightbox.co.uk/page/wp-­‐content/uploads/2010/12/Light-­‐Box-­‐
PDF-­‐Project-­‐Report.pdf /
“Coming h ere has h elped me cope with a very difficult time.” Participant 10
2.6 Funding and Finance
Funding for the 2011 3-­‐month Happiness Project was received from the following charitable trusts:  Arts Council England  The Lankelly Chase Foundation  Big Lottery Fund Payment was received from Artshine, NHS Bristol’s arts on referral s cheme, in exchange for the provision of workshops to General Practice patients. Statements of income and expenditure are included as Appendix B. /
“I find the workshops very enjoyable and calming. It h elps me relax and get in touch with a creative s ide I thought I didn’t have.” Participant 11
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People
Participants using drawing inks and letterpress stamps to decorate their hand-bound
gratitude journals
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3.1 Stakeholders
Light Box has engaged with the following s takeholders:  Third s ector organisations including Second Step and Bristol Mind.  Avon and Somerset Probation Services  Bristol City Council  NHS Bristol  General Practice Surgeries in the Bristol area  Avon and Wiltshire Mental Health Partnership NHS Trust Representatives from the majority of these organisations attend Light Box’s stakeholder meetings twice a year. These meetings update stakeholders on recent progress, and invite them to contribute ideas as to h ow Light Box could best d evelop to meet their clients’ n eeds. These meetings make use of an Appreciative Inquiry approach.1 1
An asset based approach to p erformance appraisal. 13
3.2 Partnerships
Light Box has worked with s everal referring partners, including:  Happy City Initiative  ArtShine arts on prescription scheme  Early Intervention in Psychosis Team  Eden House Project The Happy City Initiative promotes Light Box to the broader community, encouraging s elf-­‐referral. Art Shine refers General Practice patients to take part in Light Box workshops d esigned for the general public. The Early Intervention Team and Eden House Project refer their clients ( young p eople and women in the offender management s ystem) to take part in closed 10-­‐week courses. /
“I like the colours in h ere. I like how there ‘s a big table for lots of p eople to s it around and also corners to stand in and have s maller chats.” Participant 14
3.3 Volunteers
Light Box has a team of 19 volunteers from d iverse backgrounds, ranging in age from 19 to 60+ years of age. 9 volunteers are ex-­‐workshop participants. The volunteer role is d ynamic. Volunteer tasks include but are not limited to:  IT -­‐ technical support  Web d esign  Social media  Sourcing workshop materials  Reception d uties  Promotion and public relations  Assisting with workshop facilitation  Assisting with workshop d evelopment  General h ousekeeping  Evaluation Light Box holds quarterly volunteer steering group meetings. Here volunteers input ideas a bout the d evelopment of their role and the organisation as a whole. All volunteers receive induction training, which covers safeguarding vulnerable adults, evaluation, h ealth and safety, boundaries, active listening and positive psychology. They receive ongoing supportive supervision. /
“I enjoyed the practical part of the workshop as I’ve got results from it as it’s very n urturing.” Participant 15
3.4 Participants
From April 1st to June 30th, general workshops were attended b y:  201 members of the public  11 General Practice patients enrolled on ArtShine, the arts on referral scheme And 10-­‐week courses were a ttended b y:  14 clients referred by Avon a nd Wiltshire Partnership’s Early Intervention in Psychosis Team  14 Women enrolled with Avon and Somerset Probation Services Eden House Project /
“This is brilliant, a nd n eeded” Participant 16
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Project evaluation
part of The Monitoring station
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4.1 Background
In October 2010, Willis Newson, an arts and h ealth consultancy, agreed to provide evaluation s ervices through the company’s Knowledge Transfer Partnership ( KTP) with the University of the West of England (UWE). The evaluation model adopted was that of a guided internal evaluation, with Meg Attwood ( Willis Newson) and Norma Daykin ( UWE) providing training and mentoring in evaluation d esign and implementation of an evaluation protocol, as well as assistance with data analysis. Overall project management of the evaluation was undertaken by The Happiness Project. /
“I was on my last legs and found this experience more than just refreshing. God bless you and your project.” Participant 18
4.2 Rationale
Light Box wanted to achieve the following objectives in evaluating their Happiness Workshops:  To consistently apply a robust evaluation framework  To produce evidence to support the programme  To inform best practice  To ensure they were in line with the current h ealth policy a genda, i.e. d elivering evidence based practise and evidencing outcomes /
“I feel stronger.” Participant 19
4.3 Approach
The internal evaluation framework was d eveloped in p artnership with the Light Box team to ensure that it would support evaluation a ctivity that was appropriate, feasible to implement and sustainable. Evaluation capacity was developed through a day of team training and a guided evaluation cycle with supervision from Willis Newson/UWE. /
“Light Box has opened my eyes to my own creative p otential” Participant 20
4.4 Project aims
At the start of the evaluation process, a priority-­‐setting meeting was h eld with a group of key stakeholders in order to explore the a ims of the evaluation. Based on this discussion the following evaluation priorities were identified:  To assess the impact of the activity on participants’ mental h ealth and well-­‐being  To assess the impact of the activity on participants’ take up of further creative occupational activity  To explore the impact of the project on participants’ empowerment and level of s elf care  To assess the impact of the project on reducing stigma surrounding mental h ealth  To assess the impact of the project on the community’s understanding of happiness  To assess awareness and p erception of the project as a resource  To identify and d evelop b est working practices within the organisation /
“I’m so glad I found this.” Participant 21
4.5 Data collection methods
Monitoring
Monitoring information was gathered at each workshop including: gender, a ge, disability and ethnic background. Session feedback forms
All participants were asked to complete a feedback form upon completion of each workshop. The form was devised b y the evaluation team and included quantitative q uestions on issues such as subjective impact on well-­‐
being, uptake of creative pursuits, feelings of empowerment and understanding of happiness, as well as qualitative questions to explore planned actions and a ny other comments regarding the workshops. A sample feedback form is a ttached as Appendix C.
Case study interviews
All of the workshop participants were invited to b e case studies. Sixteen case studies were selected to represent participants of varying a ge and gender, and to represent both those who had a ttended the ten-­‐week courses and the general workshops. Case s tudy interviews were conducted over the phone and the interviewer, a project volunteer who had undergone evaluation training, took notes. Questions covered themes including participants’ experience of mental health and mental h ealth s ervices, any changes they had made as result of the workshops and whether they had felt empowered to look after and improve their mental well-­‐being. Warwick-Edinburgh Mental Well-being Scale (WEMWBS)
The Warwick-­‐Edinburgh Mental Well-­‐being Scale (WEMWBS) is a 14 item scale of mental well-­‐being. All of the items are worded positively and cover aspects of positive mental health, such as feeling optimistic about the future, feeling close to other people and b eing interested in n ew things. Each of the 14 statements in the scale are scored from 1 (none of the time) to 5 (all of the time) and the respondents’ total score is calculated by adding the 14 individual scores. The minimum possible score is 14 a nd the maximum, 70. This s cale was completed b y case studies and closed group participants at the beginning and end of their attendance, in order to track changes in well-­‐being. Comments box
A comments box was used to gather spontaneous feedback from passers-­‐by a nd participants. Respondents gave their feedback voluntarily and were advised that it would b e used as part of the evaluation. Consultation
Throughout May, all of the Happiness Workshop’s participants were invited to join a steering group, which 12 participants from both the general workshops and closed groups joined. Steering group meetings take p lace twice yearly and provide an opportunity for participants to make recommendations about the project’s improvement. 22
Weekly team meetings with volunteers are also h eld to discuss and respond to any issues that were flagged up by the feedback forms and participant steering groups. Ethical guidelines
As the Light Box team undertook a s ervice evaluation a nd not a research study, formal ethical a pproval was n ot needed for the evaluation. However, ethical principles including respect for participants’ rights, safety, privacy and dignity were adhered to and all evaluation activities conformed to current legal requirements surrounding data protection. Participants provided written informed consent for all information gathered including feedback forms, WEMWBS and case study interviews. When completing evaluation forms participants were asked to use a pseudonym, which they retained throughout the project, enabling the project team to match participants’ data at the same time as keeping participants’ identities anonymous. All of the data were s tored s ecurely in a locked filing cabinet and identifying b iographical information was kept separate from responses. When photos were taken d uring the workshops the participants provided verbal consent for them to b e used as part of the project evaluation. /
“Many thanks. Marvelous idea, great! Keep up the good work you lovely p eople.” Participant 23
4.6 Data analysis
Quantitative analysis
Simple quantitative data analysis was p erformed on the monitoring and feedback information, as well as the WEMWBS responses. This analysis produced total scores, percentages, frequencies and a verage values. Qualitative analysis
Thematic analysis was used to identify the key themes that emerged from the case study interviews a nd the responses to the qualitative questions in the feedback form. /
“Thank you. You have made a big d ifference to my life.” Participant 24
4.7 Results
Quantitative results
Monitoring
Gener al p ublic w ork s hops
201 members of the public a ttended the workshops. Of these, 11 were referred through ArtShine. 57 members of the public attended more than one workshop and this resulted in a total of 416 a ttendances over the duration of the workshop programme, with an a verage attendance of 2 workshops per p erson. 25
Of the total number of participants who a ttended the course of general public workshops, 16% were male and 82% were female (2% did not respond to this question). In terms of the ethnic monitoring data, 93% of participants were White British, White Irish or White other; 6% were from black and minority ethnic groups and 1% d idn’t respond. 26
43% of the participants had a d isability, 45% did not, 10% preferred not to say and 2% did not provide a response. A range of a ges was represented with 4% of participants b etween 0-­‐19, 28% b etween 20-­‐29, 27% b etween 30-­‐39, 16% between 40-­‐49, 17% b etween 50-­‐59, 6% 60 plus a nd 2% not responding.
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Monitoring
Closed gr oup w ork s hop s
28 participants came to the closed group workshops. 10 participants attended more than one workshop. This resulted in a total of 71 attendances over the 10-­‐week course, with an average attendance of 2 workshops p er person. Of the total number of participants who a ttended the course of closed group workshops, 37% were male and 63% were female. In terms of the ethnic monitoring data, 93% of participants were White British, White Irish or White other and 7% were from black and minority ethnic groups. 28
39% of the participants had a d isability, 41% did not a nd 20% preferred not to say. The age range of participants was as follows: 11% of p articipants were b etween 0-­‐19, 48% b etween 20-­‐29, 17% between 30-­‐39, 14% b etween 40-­‐49, 6% between 50-­‐59, 1% 60 p lus and 3% not responding. 29
Feedback
412 feedback forms were completed b y members of the public. The response rate to the feedback forms was extremely high a t 99%. 67 feedback forms were completed b y closed group participants. The response rate to the feedback forms was again high at 94%. Participants’ responses to the feedback forms are presented below. Imp act on w ell- being
In the general public workshops, 96% of respondents found the workshops enjoyable and 93% found the workshops either useful or very useful. In the closed group workshops, 100% of respondents found the workshops enjoyable and 97% found the workshops either useful or very useful. ‘I don't know what I would have done this m orning if I could not have come here because I was very distressed but now I feel m uch better.’ ‘As usual, life affirming, brilliant and positive, thanks.’ T ak e up of creat iv e and occup at ional activit y
80% of the general public respondents and 81% of the closed group respondents p lanned to spend more time on creative pursuits. ‘I played the violin for the first time in a year last night.’ ‘Be more creative and get out there and do, not just think about it.’ Emp ow er ment
In the general public workshops, 75% of respondents felt empowered by the experience of participating and 89% planned to take action as a result of attending. In the closed group workshops, 78% of respondents felt empowered by their participation and 94% p lanned to take a ction. ‘I’m glad I came to this workshop again as it has given me the inspiration to carry forward with what I intend to do.’ ‘It was great to come to this workshop again. It would be nice to volunteer if I can.’ ‘Make a new start that can make m e different.’ 30
S ti gma
79% of the general public respondents and 69% of the closed group respondents felt that the workshops had helped them s ee how mental h ealth applies to a ll of us. ‘Very refreshing approach to m ental health. More please!’ Under s t andi ng of happ i nes s
71% of the general public respondents and 60% of the closed group respondents had improved their understanding of happiness. ‘Excellent! A brilliant, fun way of bringing the benefits of positive psychology to a broader audience.’ T he p roject as a resource
97% of both the general public and closed group respondents said they would recommend the workshops. ‘These workshops should be more available, they are really good for everyone.’ ‘Great initiative that deserves to continue and grow throughout the city and beyond.’ ‘It’s fantastic that it’s free.’ S ucces sf ul w ork i ng p ract i ces
In the general public workshops, 77% of respondents s aid that the workshop length was just right and 94% felt that the information was clear. In the closed groups, 81% of respondents found the workshops length to b e just right and 100% said that the information was clear. ‘I am so impressed with your ability to communicate complex and potentially life changing ideas in a simple and powerful way.’ ‘You guys are so eloquent in the way you explain such a wonderful project.’ 31
Warwick Edinburgh results
Case s tudy participants were asked to fill in an initial WEMWBS on s election as case studies. The second WEMWBS was collected at the end of participant’s engagement with workshops. All of the 13 case s tudy participants showed an improvement in their well-­‐being scores, as measured b y the Warwick-­‐Edinburgh Mental Wellbeing Scale (WEMWBS) at the beginning (pre-­‐test) and the end of their workshop attendance (post-­‐test). The a verage WEMWBS score changed from 42.1 at pre-­‐test to 49.8 a t post-­‐test, indicating an average change in score of 7.8. The average pre-­‐test s core of the case s tudies (42.1) is below the p opulation mean (50.7). This suggests that the project is reaching people within the general public who have lower than average well-­‐being. (Stewart-­‐Brown and Janmohamed, 2008). 32
We initially p lanned to collect WEWBS scores at 3 time points; the b eginning, the middle and at the end of the 10-­‐
week course. Due to the attrition and sporadic a ttendance of some participants, WEWBS scores were collected at 2 time points; n ear the b eginning and at the end of the workshop attendance. Of the 28 participants in the closed groups, 8 returned both the pre-­‐ and p ost-­‐measures. 7 of these 8 participants showed an improvement in their well-­‐being scores, while one participant’s score d ecreased a t post-­‐test. The average WEMWBS score changed from 40.3 at pre-­‐test to 46 a t post-­‐test, indicating an average change in score of 6. The average pre-­‐test s core of the closed group participants (40.3) is b elow the population mean (50.7). This suggests that the closed groups targeted p eople with lower than a verage well-­‐being. 33
Qualitative Results
The themes that emerged from the s ession feedback forms under the categories ‘planned action’ and ‘comments’ are presented below. I plan to...
Engagement i n Cr eat iv e act i vi t ies
Several participants stated a n intention to engage with a range of creative activities in general life as a consequence of a ttending the workshops. Examples included: journaling, photography, gardening, sewing, knitting, joining art groups and attending concerts and dance classes. Promoting w ell- being
Plans to invest more in physical well-­‐being were a recurring theme. Examples included: Increasing levels of physical activity with an emphasis on ‘green exercise’ such as walking and cycling, making positive changes to diet and upping daily intake of water. Imp r ov ing soci al r elati ons hi p s
People a ttending often viewed coming as an opportunity to meet and mix with n ew p eople. Much of the feedback d emonstrated an increased resolve to nurture existing relationships, using kindness and gratitude, and to d evelop n ew ones b y mixing more socially. A number of participants expressed a d esire to share the information they had acquired from the workshops with others in their social n etwork, and n ine joined the volunteer team that h elps run the project. ‘Excellent! A brilliant, fun way of bringing the benefits of positive psychology to a broader audience.’ Purp osef ul act i ons
Specific intended a ctions arising from the workshops included s etting and pursuing meaningful goals; seeking beauty in the natural and man-­‐made environment; employing the senses to savour more experiences in daily life; taking up meditation; and making extra time for activities that induce flow states 2. The time and effort involved in habit creation and change was noted by case studies. The roles of enjoyment and awareness of p ersonal character strengths were identified as h elpful tools in this process of change. 2
A term used to describe the emotional equilibrium experienced when engaged in a task d emanded a level of skill at the top end of your capability (Csikszentmihalyi, 1990). 34
Comments
P os iti v e exp erience
Participant feedback predominantly indicated pleasure in a ttending: friendly, relaxed, joyful, p layful and fun were all used as d escriptions of the experience. A s ense of having one’s ability recognised was cited and there was a general acknowledgement that the approach taken b y the workshops was ‘new’ or ‘refreshing’. One participant d escribed their experience as life affirming. It was reported that the workshops presented an opportunity to think clearly about their well-­‐being. Participants described the workshops as providing inspiration, insight and motivation that facilitated their taking action to invest in good mental h ealth. Participants a lso d escribed improvements in mood as an immediate effect of attending. ‘I don't know what I would have done this morning if I could not have come here because I was very distressed but now I feel m uch better.’ T he w ork shop e nvi r onment
Feedback variously d escribed the shop space as welcoming, safe and accessible, with a good atmosphere. The selection of music p layed in the shop met with general approval, although a participant did report that the music coming in from the gallery outside was d istracting. Communi cati on Participants d escribed the workshop content as informative and credible. Appreciation was expressed for the scientific d etail, and the way in which practical application of the theory and research was made clear. The opportunity to discuss concepts in a group s etting was also reported as enjoyable and b eneficial. A s mall number of participants said they would have liked to receive more instruction during the creative activity and had it presented in a more s tructured way. ‘I am so impressed with your ability to communicate complex and potentially life changing ideas in a simple and powerful way.’ ‘It’s nice to focus on the good things in life.’ ‘Excellent! A brilliant, fun way of bringing the benefits of positive psychology to a broader audience.’ Challenges
While most of the comments were positive, some participants identified challenges, reflection on which will guide future project d evelopment. For example, some participants felt that some activities were rushed; they would have liked more time to spend on d iscussion and artistic a ctivity. Others found the experience challenging, with a small number of participants finding b eing in a large group a source of anxiety. One participant fed back that they experienced the workshop as simplistic and patronising, b ut went on to note – ‘the atmosphere was cheerful however.’ Two participants who had physical impairments (for example limited mobility in the hands) found it difficult to take part in all aspects of the creative activity and reported feelings of exclusion while a ttending. 35
Case study interviews
Some case s tudies s elf-­‐referred after walking past the shop front, p icking up leaflets or s eeing the project advertised in Spark magazine. Others were referred by ArtShine at their GP surgeries or the Early Intervention in Psychosis team. Initial impressions of the project ranged from curiosity to scepticism, with some having little to no expectation regarding outcome. Participants widely commented that the project offered a n ew and a lternative approach to gaining insight on mental h ealth, and experienced the approach as enjoyable, p layful, fun and light-­‐hearted. All of the case s tudies had an existing knowledge or experience of mental h ealth. Some participants reported lived experience of mental health difficulties including depression, b ipolar disorder and anxiety. Case s tudies talked about their experience of existing drug treatments, and talk therapies including stress management training, cognitive b ehavioural therapy a nd anxiety support groups. In some cases support previously received was felt to have b een useful and in others less so. Over-­‐use of d iagnostic labelling and n ot being treated as a whole p erson or individual was a common observation. Lengthy waiting lists were a lso cited as a problem. ‘I find the Light Box creative; it m akes you feel like s omebody. Whereas in m y opinion other services, like with hospitals or m edication, you can feel like a puppet.’ During the interviews, some participants talked about the challenging circumstances and traumatic life events that they felt had played a precipitating role in the mental h ealth d ifficulties they experienced. Interviewees referred to single-­‐parenthood, relationship breakdown and job loss as contributing factors. Thematic analysis identified the following themes from the case study interviews. Balance
The positive, s olution-­‐focused approach of the workshops was praised as a useful counterbalance to the more clinical, diagnostic approaches of conventional treatments. The fact that the workshops felt ‘less serious’ and normalised mental h ealth was seen as a b enefit. Placing emphasis on well-­‐being rather than illness was also welcomed and case s tudies d escribed this aspect as empowering. One case study observed that rather than fixing p eople, this was a method of building strength and resilience. The project’s personalised and supportive approach was mentioned as a strength, and its tendency to recognise a nd encourage the individual’s a bility to take action themselves was a lso found to b e of b enefit. Participants liked the combination of science-­‐based theory and creative a ctivity within the workshops and found the practical application, i.e. the take-­‐home reminders and actions, especially helpful. ‘I like that the s essions are scientifically based and also fun. I enjoy doing the practical exercises, I think that they are absolutely fantastic.’ S oci al element
Case s tudies felt that attending h elped build confidence and group s kills and present them with social opportunities, a chance to meet and be around happy people and build supportive relationships and networks. ‘Light Box is aimed at m ental health but actually you also build group s kills, which are helpful.’
36
Unlocki ng cr eat iv it y
A number of case studies felt that having the opportunity to b e creative and explore the creative process using methods of art, craft and p hotography, encouraged them to continue exploring and d eveloping creative aspects of their lives b eyond the workshops. ‘It has empowered m e to build on the creativity I already have in myself.’ Personal dev elop ment
Several of the case studies d escribed a shift in outlook which they a ttributed to a ttending. Feeling more in control and taking things less seriously were examples given, a s was an increased ability to ‘live in the present’ and b e focused on the future rather than the past. ‘Booking into the workshops has made m e more proactive.’ Developing resilience, facing challenge and d isappointment and b ecoming more able to cope were aspects of personal growth that case studies felt attendance had assisted with. Receiving encouragement to identify existing strengths and d evelop n ew s kills was s een to p lay an important role in the confidence b uilding aspect of the workshops. Increased s elf-­‐knowledge and s elf-­‐awareness were also reported consequences of taking part. T aking action
One case study reflected on the challenge of putting the recommendations from the workshops into a ction a nd becoming proactive after a long p eriod of d epressed mood and inactivity. Attaching importance to doing enjoyable things with the understanding that they are a means of investing in good mental h ealth was an insight another case study d escribed taking from the workshop. ‘Light Box gives you things that you can take away and use on yourself. It is logical, it makes s ense. The practical ideas have really helped.’ Consciously cultivating gratitude, appreciating b eauty, and performing extra kind acts and s miling more were reported as actions that case studies had found particularly useful as tools for investing in well-­‐being. 11 of the 13 case s tudies said that s ince a ttending the workshops they felt b etter able to a ctively improve their own mental health. Holi s ti c
The two V itality Workshops, which examine the role of food and physical activity in mental well-­‐being were reported to have made a particular impact in terms of case s tudies’ b ehaviour change. Increased exercise and improvements to diet were reported b y s ix of the thirteen respondents. ‘I have changed my diet and am particularly drinking a lot m ore water.’ P os iti v e resp onses
Case s tudies’ overall response to the workshops was a positive one. They were d escribed as helpful, welcoming, fun, enjoyable, clear and as making a big d ifference. ‘I would like to commend the people involved in the workshops. I found them to be professional, and they gave m e assurance.’ 37
Challenges and areas for improvement


Case s tudy feedback drew a ttention to the fact that the majority of workshops being scheduled during weekdays raised an issue of a ccessibility for those in full-­‐time employment One respondent felt that the facilitators’ lack of professional clinical training ought to be highlighted 
Having more opportunity to share and d iscuss experiences with other participants was suggested as a potential improvement 
One case study experienced a panic attack during a workshop that involved d ismantling and cutting up old toys, and questioned the appropriateness of this workshop activity for vulnerable adults 
The explanation of h edonic adaptation theory 3during the workshop introduction seemed like too b ig a generalisation, and counter-­‐intuitive to one of the case studies, who felt it should b e dropped from the content 
Others cited the n eed to leave the shop to use the public toilets as an inconvenience Actions to b e taken on these points are d iscussed under Recommendations /
3
A term used to d escribe the emotional equilibrium experienced when engaged in a task d emanding a level of skill at the top end of your capability ( Csikszentmihalyi, 1990). 38
4.8 Discussion
Evaluation process
The evaluation framework developed in partnership with Willis Newson and UWE has shown itself to b e an effective and sustainable means of gathering data that will inform the project’s d evelopment. Before the second evaluation cycle b egins in autumn 2011, minor alterations will b e made to the session feedback forms and methods of data entry to increase their efficiency. Aims
The workshops have b een shown to provide an effective, solution focused approach to supporting mental h ealth and well-­‐being. Participants found the workshops engaging, enjoyable and of practical b enefit. Following attendance, the majority of participants felt empowered to take a ction to improve their well-­‐being, and participants saw the project as a useful resource. This supports the case for the project’s continuation. Observations
The monitoring data has h ighlighted the fact that the majority of participants in both the general public and closed groups were female, and that participants from BME groups were underrepresented. A range of a ges was represented and the programme showed itself to b e a ccessible for p eople with d isabilities. There were n ear-­‐
equal p ercentages of participants with and without stated disabilities. Attendance on the closed group workshops was lower than expected and participants tended not to b e regular attendees, dropping in to sessions, rather than attending for the duration of the 10-­‐week programme. The increase in the WEWBS scores suggests an improvement in participants’ well-­‐being over the course of their workshop a ttendance, but as the sample size is limited, and it was not a lways possible to collect the scores a t the planned pre-­‐ and post-­‐ intervals, this finding should b e interpreted with caution. Considerations of group size and physical disability as a barrier to participation, that were raised b y case studies are a lso of concern. The measures to b e taken in response to these issues are d iscussed b elow as recommendations. Participant involvement
9 participants b ecame volunteers, showing there was opportunity for workshop participants to b ecome a ctively involved in the project’s d elivery. A number of suggestions put forward b y the participant and volunteer steering groups, and obtained through case s tudy and s ession feedback, were implemented for the n ext instalment of workshops. This demonstrates there was opportunity for participants to input into the project’s planning. 39
Funding and finance
Additional income sources are n ecessary for the continuation of the project. At the time of writing, all core staff posts are un-­‐salaried. Light Box is s eeking to d evelop a financially sustainable approach to working whereby it is paid b y the local authority and h ealth bodies for its s ervices. This has b een shown to effectively support the p ublic promotion of mental h ealth and well-­‐being in Bristol. /
“….Had a fantastic time and discovered a ll sorts of useful n ew thoughts and a ctivities.” Participant 40
4.9 Recommendations
The following a ctions will be taken forward, as a result of the project evaluation:  Light Box will target future promotional and marketing activities in order to engage BME populations, and increase the n umber of male participants. Initial action should include making d irect contact with BME community representatives in the third s ector, in order to offer outreach introductions to their clients  From 2012, Light Box will make 2 weekend workshops available each month to h elp those in full time employment access the s ervice  The professional background of facilitators will b e stated in every workshop  Participant catch-­‐up groups will b e h eld fortnightly, providing participants with additional opportunities to discuss their experiences of implementing the recommended a ctions with each other  People b ooking onto a ll future workshops will b e asked if they have any physical a ccess n eeds, and will be advised on the appropriateness of various workshops where n ecessary  Publicity materials will highlight maximum group s ize, and the option of s mall group b ookings for workshops will b e presented to S ocial Anxiety West  Reference to h edonic adaptation theory in the introduction will be re-­‐worded  More time will b e spent introducing potential closed group participants to the course, its structure and outcomes they can expect. A broader range of support agencies that work with these client groups will make referrals Light Box will continue to gather data from the closed group participants and case studies using the WEWBS. This will ensure that they are able to add to their existing d ata set and begin to build a stronger case for improvements in well-­‐being for participants during the programme. 41
5
The Happiness Project: next
installment
Group discussion: thinking of ideas in the Vitality 2: Movement workshop
42
5.1. Autumn workshops
An Autumn timetable of workshops has been scheduled to run from S eptember 19th, 2011. Following the summer programme, all 10 workshops underwent revisions, as a result of participant feedback. The following suggestions from the participant steering group meeting in June have also b een integrated into the timetable and workshops: • Away-­‐days have b een added to the timetable. These will assist with participants’ exploration of broader artistic practices and themes. Land-­‐art exercises where a group art work is created using natural materials in green space, and guided trips to art exhibitions will feature as away-­‐day activities • The shop will b e open in a drop-­‐in capacity for 2 days a week, in addition to s cheduled workshops. As a drop-­‐in space, a ctivities such as ping-­‐pong, collage and stop motion a nimation will b e a vailable to the public without pre-­‐booking /
“It’s just s o much fun” Participant 43
5.2 On from Autumn
In January 2012, a n ew set of 10-­‐week courses for women at risk of offending and young p eople experiencing mental h ealth difficulty will commence. Existing partners Eden House Project a nd the Early Intervention Team as well as other organisations in the third s ector will refer their clients to take part in these courses. /
“Well done you all, a real inspiration about what can b e achieved.” Participant 44
6. Conclusion
This report h ighlights the success of the project in achieving its a ims, as well as identifying areas for improvement. Key recommendations will b e taken forward into the n ext installment of the project.
45
7. References
Cayton, H ( 2007). The report of the review of arts and health working group. London: Department of Health. Available from: http://www.dh.gov.uk/en/Home Accessed: 19 S eptember 2011. Clift, S. et a l. ( 2009) The state of arts and h ealth in England. Arts & Health.1(1): pp.6-­‐35. Compton, W. C. (2005) An Introduction to Positive Psychology. Connecticut: Wadsworth Publishing. Csikszentmihalyi, M. (1990) Flow: The Psychology of Optimal Experience. New York: Harper and Row. Department of Health with Arts Council England. (2007) A prospectus for arts and health. Available from: http://www.artscouncil.org.uk/documents/publications/ Accessed: 19 S eptember 2011.
Duggan, L. / Light Box. ( 2010) Light Box Project Report. Available from: http://wearelightbox.co.uk/page/wp-­‐
content/uploads/2010/12/Light-­‐Box-­‐PDF-­‐Project-­‐Report.pdf Accessed: 19 S eptember 2011. HM Government. ( 2011) No Health without Mental Health: A cross government m ental health outcomes s trategy for people of all ages. Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124058.pdf Accessed: 21 S eptember 2011. Hunt, L. and Lyle, R. ( 2008) Bristol Mental Health Services -­‐ A V ision for the Future. Bristol Mental Health Local Implementation Team. Available from: http://www.avon.nhs.uk/bhsp/Services/mental_health/pro/080201_Mental_Health_Services_Vision.pdf Accessed 2 S eptember 2011. NRES ETHICS CONSULTATION E-­‐GROUP (2007) Differentiating research, service evaluation and audit. Available from: h ttp://www.nres.npsa.nhs.uk/applications/guidance/research-­‐guidance/?entryid62=66988 Accessed: 12 October 2011. Robertson, B., Gray, C. and Bramley, S . (2008) Promoting positive m ental health in Bristol: Strategic framework 2008 – 2011. NHS Bristol: Public Health Directorate. Available from: http://www.bristolpct.nhs.uk/publichealth/mentalhealth/Promoting_positive.pdf Accessed: 3 S eptember 2011. Sainsbury Centre for Mental Health. ( 2003) The Economic and Social C osts of Mental Illness. Available from: www.scmh.org.uk/pdfs/cost_of_mental_illness_policy_paper_3.pdf Accessed: 15 S eptember 2011. Secker, J. Hacking, S., Spandler, H., Kent, L. and Shenton, J. ( 2007) Mental Health, Social Inclusion and the Arts, Developing the Evidence Base. Available from: h ttp://www.socialinclusion.org.uk/publications/MHSIArts.pdf Accessed: 12 October 2011. Seligman, M.E.P. and Csikszentmihalyi, M. ( 2000) Positive Psychology: An Introduction. American Psychologist. 55 (1): pp. 5–14. Stewart-­‐Brown, S . and Janmohamed, K. (2008) Warwick-­‐Edinburgh Mental Well-­‐being Scale ( WEMWBS). User Guide: V ersion 1. Available from: http://www.healthscotland.com/uploads/documents/7551-­‐
WEMWBS%20User%20Guide%20Version%201%20June%202008.pdf Accessed: 23 November 2011. 46
8
Appendices
Collaging during the goals session
47
Appendix A Workshop time table, April – June 2011 48
Appendix B Income and Expenditure April -­‐ June 2011 Total Budget
Artshine
Arts Council
£5,000.00
£10,000.00
£35,000.00
Area
Staff Salaries
Budget
12,800.00
120.00
49.30
Art Materials
5,970.00
4,317.98
Capital Expenditure
1,250.00
1,261.69
Premises Fixtures Fittings
3,212.00
2,889.50
Evaluation
6,300.00
6,300,00
Advertising Marketing
1,218.00
1,010.80
Exhibitions
600.00
448.99
Printing Postage Stationery
500.00
397.28
Transport
400.00
399.12
Refreshments
300.00
113.61
Financial
620.00
1,177.60
1,710.00
1,836.18
35,000.00
25,312.38
Contingency
AFA Lottery
£10,000.00
Spent
12,800.00
Volunteers
Llankelly
Chase
£10,000.00
49
Appendix C Feedback form 50