Contents

Page No

Introduction 1

Background 3

Chapter 1 What Would You Like? 7

Chapter 2 Not Alone Anymore 11

Chapter 3 Give A Man A Fish 14

Chapter 4 The Seed of Change 16

Chapter 5 10,000 Kicks 34

Chapter 6 Starting Over – A Road to New Beginnings 42

Chapter 7 Professional Perspectives 47

Chapter 8 Facts and Figures 58

Chapter 9 Conclusion 61

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Introduction

The purpose of this book is to describe a ‘recovery through learning’ focussed model and experiences that sees the joining together of two professional services, specialising in both the personal as well as the education aspects of recovery. This joining is a 2 year Community Learning Mental Health research project being delivered in Knowsley called ‘FACE Forward’. The project is part of a national research study funded by the Skills Funding Agency sponsored by the Department for Education and the Department of Health and National Health Service (NHS). FACE Forward is a partnership between Knowsley Council’s Family And Community Education Service (FACE) and the NHS 5 Boroughs Partnership Foundation Trust (Recovery Service) working with individuals looking to recover from mental illness and move on in life. FACE represents ‘learning and education’ and Forward represents ‘recovery through learning – a solution focussed recovery’.

The book presents a reflection of FACE Forward Year 1 and the authors are presenting this reflection coupled with their combined experience of over 25 years in both the Mental Health Profession as well as the Adult and Community Learning Sector. It is as a result of this combined experience that the authors are able to credibly evaluate the impact that adult education has on mental health outcomes and this message is reinforced and reiterated throughout.

The book presents and discusses outcomes, research findings and personal, powerful accounts from participants and

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perspectives from a range of experienced professionals, all of whom have been involved with FACE Forward.

The book may be of relevance to anyone who has an interest in mental health or adult/community education.

Also presented are some of the success stories written by FACE Forward project participants and experts by experience who were inspired and supported by the project to start their own community social enterprises. Two of these community groups (Starting Over and The Women’s Room) now run independently, providing access to physical exercise, sporting opportunities and much needed peer support to mental health participants and female survivors of domestic abuse. The groups are now also a part of the FACE Forward recovery network.

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Background

Historically, Community Mental Health teams have adopted a medical (medication altering) model and together with the offer of individual psychological therapies, mental health services have somewhat restricted themselves and participants in options for recovery for participants. Working this way for many years has led to professionals struggling to change their ways of working and to adapt to a more holistic approach to care. It could be argued that this has also created a dependency for participants who have developed a reliance on the only model they know thereby limiting or removing their independence – a key factor in personal recovery. This research seeks to challenge the historical medical model to create more personalised recovery options with the aim of creating independence and self-management of mental health symptoms.

There are many reasons to integrate an alternative or complementary road to recovery. For instance with regards to physical health, it is widely known that most medication used to treat mental health symptoms has a number of negative side effects. The most common of which is weight gain. When services are prescribing or increasing these medications we have a duty of care to participants to offer complementary courses/groups providing an opportunity to reduce or sustain their weight in a healthy way. With this in mind, FACE Forward designed a ‘Living Life Well’ course which provided education and practical opportunities for healthy eating, healthy cooking, physical exercise and an awareness of the effects that medication may have on the body. Also provided was a session on drug and alcohol awareness for participants who may use these as coping strategies.

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There is evidence to suggest these two issues are in need of addressing, particularly in Knowsley. Adults who experience mental health conditions in Merseyside and the surrounding areas are of a higher risk of poor health and premature morbidity.

Up to 23% of ill health in Knowsley is due to mental health disorders and just under 4,000 adults in Knowsley are in contact with mental health services.1

There is extensive evidence that people with serious mental illnesses, such as schizophrenia, are at risk of dying on average 20 years prematurely (Rethink Mental Illness, 2012). Compared with the general population, they have2:

• 2 times the risk of diabetes. • 2-3 times the risk of hypertension. • 3 times the risk of dying from coronary heart disease. • 10-fold increase in deaths from respiratory disease for

people with schizophrenia. • 4.1 times the overall risk of dying prematurely (than the

general population aged under 50).

There are also many other obvious benefits to, and reasons why, recovery through education and exercise opportunities should be embedded within mental health interventions. Exercise helps to naturally release the positive ‘feel good’ chemicals that medicine attempts to replicate, but those who experience

1 Knowsley Council Strategy 2016-2020 2 (Report of the National Audit of Schizophrenia (NAS) 2012).

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mental health conditions are not getting their recommended average weekly exercise because of the stigma attached to mental illness and lack of confidence. This stigma creates barriers that prevent those who experience mental health conditions from taking a positive part in society and accessing sports facilities that they are entitled to do so. Their anxiety and lack of self-worth increases, which leads to further social isolation, and quite often to a temptation to self-medicate on drugs or alcohol.

The stigma still attached to mental health can make it difficult to encourage learners to open up and engage in such activities and courses. This is challenged by community learning providers such as FACE who specifically capture reasons why individuals want to engage in learning. There is an increasing number of individuals who now identify ‘to improve mental health’ or ‘improve confidence and self-esteem’ as a reason for learning at the point of joining. In previous years, very few individuals would openly declare this and instead would indicate ‘other reason’ or ‘health/well-being’. FACE, as a whole service, has been asking questions for several years at the point of enrolment and in end of activity surveys that specifically relate to mental health and which fit with Recovery Star outcomes. Statistics are available from a range of data gathering and whilst data, numbers and percentages present a picture – they do not tell the whole story. A true value can only be gleaned from each individual’s experience, hence the importance of the participant stories which are woven throughout this book.

From feedback forms, similar findings have been discovered including how playing sport and concentrating on education can block out the auditory hallucinations associated with

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schizophrenia, how people feel less anxious and are drinking and smoking less. In general, all participants felt fitter and healthier which would suggest ‘recovery through learning’ is also a successful preventative measure for physical illness as it enhances physical and mental well-being.

Stigma negatively affects those who experience mental health condition: Their right to enjoy an active and healthy quality of life or access education and training to seek employment can become blocked through discrimination or fear of ridicule. It is imperative that more adequate and accessible education and leisure activities are made available to our service users that are free from stigma and discrimination. Such real activities improve mental well-being, increase opportunities of paid or unpaid employment, enable individuals to get fit, improve social skills, gain confidence, make friends and address problems of isolation. The following account is from a participant who benefits from attending groups.

‘When my mental health first started to deteriorate I felt totally

isolated. I was experiencing emotions, thoughts and behaviours completely alien to me. ’

One of the authors feels that the best way to describe his own personal view and background on mental health recovery is to describe the story of a person he worked with at the beginning of his career. His university education consisted of lots of education about the medical model, mental capacity and safeguarding aspects for example, however very little on personal recovery or social inclusion.

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Chapter 1: What Would You Like?

This chapter is about the personal recovery of Bob written from the personal perspective of a Senior Mental Health Practitioner. It displays the typical characteristics of how care is historically delivered in mental health recovery. With the implementation of minor changes in approach and outlook, there are amazing rewards and benefits that can be reaped by many.

This is the personal recovery story of Bob.

‘Early in my career during my time as a student, my first review with a community mental health team always remains in my memory. It was with a participant (Bob) who has a long-standing diagnosis of Schizophrenia and who had been challenging to engage with. Bob had been in services for a number of years and had tried most therapies and medications without any real success.

Bob had typically displayed no real improvement since his last medication increase at his previous review and this was clearly a great source of frustration to Bob’s mother who played a vocal part in the appointment.

During the review, medications were discussed with the doctor suggesting a further increase which was accepted by the participant who was eager to end the review at the earliest point and get out of the room. It was a review that was fairly typical of how care was implemented to most participants at this time and I remember thinking that surely services had more than this to offer?

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I had read about personal recovery and the Recovery Star and felt there had to be a different approach with this type of individual and an alternative option was required without really knowing what that intervention may be.

On my next visit to the participant, rather than focus on how he felt since his medication increase, I discussed personal interests, hopes for the future and asked; ‘What would you really like to do?’ Sadly, Bob was very uncertain about the future and had no real plans however he did speak about how he used to play snooker with his father when he was younger and how he enjoyed the game. I immediately offered to go for a game with him the following week in a local snooker club. Bob accepted the offer somewhat nervously.

The following week when calling for Bob to walk to the snooker hall, his elderly mother commented on what a good mood he had been in and that he had not ‘shut up’ about going to play snooker. This made me think about how much having something to look forward to can lift your mood and in some ways provide hope. I decided to walk with Bob to the snooker hall rather than drive. I felt this would be a good chance to chat and relax Bob and get to know him.

During the walk to the snooker hall Bob catharsises about his life in general and his illness without any prompt. According to his Care Co-ordinator, Bob had never disclosed so much about himself in the clinical setting of a review or therapy session. On further discussion with Bob, he informed me that he did not feel comfortable in clinical review settings and was always wary of disclosing information about any deterioration in his mental health or feeling depressed, due to fear of being hospitalised.

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Over the coming weeks, Bob’s confidence visibly began to grow as he learned to play the game again and he potted more balls each week. He was eventually able to beat me and this gave Bob a great boost in self-esteem and was also a great ‘leveller’ in the nurse/participant relationship. We were now in an environment whereby Bob was the expert and was actually giving me tips on how to play the game!

Once Bob was acclimatised to the journey and the snooker hall, I gradually began to introduce other participants into what was becoming our first Social Inclusion group.

Slowly but surely, Bob developed a small group of friends and confidantes who had been through similar experiences. Over the next couple of weeks, the amount of phone calls made to my office by members of the group or their family and friends who may have been concerned about their mental state, dramatically reduced. That’s not to say the phone calls reduced, because they didn’t! However, now the phone calls were to ask whether the snooker group was definitely going ahead this week? Or to ask could a fellow participant attend - not to raise concerns about a group member’s mental health! Friendships and peer support ensued and that Christmas, Bob invited another participant, who lived alone and had no close family or friends, for Christmas dinner! This was not only a massive boost for both participants but gave me a great sense of pride and strengthened my belief in the power of peer support and how important it is in helping integrate people back into the community.

From being quite a complex and demanding patient, Bob began to not only use the support of his peers but support them in

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return. Bob later admitted that helping others played a large part in his recovery.

Following the success of this one group, participants decided to try to expand on this idea and start a variety of groups such as football, badminton, music, sewing and and also venture into more educational classes which is where a relationship developed with Knowsley Council’s Family And Community Education Service known as FACE. It was our aim to deliver as many diverse opportunities for engagement as possible and to strike up therapeutic alliances that were relevant to basic human support needs. From an early stage, it was clear to me that one of the benefits of working in this way was that it reduced the power hierarchy between nurse and participant and especially so since mental health professionals were working towards recovery alongside the participants. In fact, in some instances where participants would excel in different groups, the power differential was turned on its head with the participant ‘teaching’ the nurse. This provided great boosts in confidence and self-esteem for the participants involved. It became clear that individuals were ‘learning’ from their involvement in groups which struck a chord with the knowledge that these groups were potential ‘education enabling opportunities’.

‘To myself, groups I attend have helped me move forward in life and not dwell in the past. I am now looking for other groups to attend that take place in hobbies I enjoy, for example, a bigger football team, possibly playing in a league, amateur dramatics, badminton, volleyball or creative writing’. I am also looking to develop my education and English skills. All these groups I know will help not only myself but other people move further forward in their lives.’ (Bob, 2010/2011)

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Chapter 2: Not Alone Anymore

On studying a range of literature on recovery, it became apparent that working in a way that adopted a ‘recovery through social inclusion and education’ approach was actually hitting all the points of the Recovery Star. Participants were being provided opportunities to build social networks and relationships. Identity and self-esteem were enhanced which in turn provided trust and hope. People realised they held certain responsibilities to abide by group rules (set by themselves) and in some cases this broke patterns of addictive behaviours which previously had negative effects on mental health.

Group members also began to pay more attention to their appearance (self-care) and went out and bought new clothes or equipment (living skills) for when they were participating in a particular group. As Recovery developed and participants progressively ‘learned’ to manage their mental health, opportunities to volunteer (work) and become an EBE (Expert by Experience) within the groups arose. Volunteers and EBEs were also offered training from both 5 Boroughs Partnership and Third Sector agencies with the aim of the groups becoming user led peer support groups.

During these groups, participants were not only able to share experiences but also coping mechanisms and achieve the realisation that they were not alone in their experience of mental health conditions.

The sports/exercise groups available promoted physical health and helped participants manage weight issues and live a healthy lifestyle. Providing education and physical health activities is a

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really important feature of mental health recovery. Weight gain is a common side effect of anti–psychotic medication, and apart from the physical dangers of weight gain, it also has a massive detrimental effect on confidence and self-esteem. With this in mind, an award winning Living Life Well course was designed - an on-going 8 week educational programme that focuses on the physical health of mental health participants to improve lifestyles through education in healthy eating/cooking as well as through sports groups including football, badminton and a walking group. The following quotes are from group participants demonstrating how physical and mental health improves.

‘Since attending the groups, people have noticed my loss of weight. Due to attending the footy group I have noticed my increased level of fitness. Friends and family have also noticed my positive outlook to life and issues I come across.’ (KC, 2016).

‘The sports groups have helped me a lot. I had lost a lot of confidence before I started going to them. However I have now made a lot of friends and look forward to attending every week. The groups also help keep me fit and help me manage my Diabetes’. (JM, 2016).

The following stories have been provided by 5 different group participants evidencing how groups provide opportunities for individuals to share experiences and realise they are not alone in their experience of mental health conditions. These opportunities provide hope!

‘From feeling alone and isolated I had found a section of society very like myself. That in itself was a great relief. The groups I attend are as much participant led as they are professional led.

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The participants have practical experience, a knowledge that cannot be learnt from a book. A common bond unites. A common theme that is apparent and often spoken of is the confidence one gains within the group, and subsequently this is taken out into life.’ (1)

‘I know that I am not alone anymore because the other members of the groups don’t look at me as a weirdo or lunatic. I am looked upon as a friend and we are all friends together within the group and are all there for each other, should we ever need that shoulder or just a pair of ears.’ (2)

‘To myself groups I attend have helped me move forward in life and not dwell in the past.’ (3)

‘Having sports activity in our lives helps us in many ways. The most obvious is it helps us keep on top of one of the most common problems people on medication find themselves up against which is weight gain. Apart from that it contributes to us living a healthy lifestyle and gives us the opportunity to be around people who have experienced similar mental health problems. I find groups give me many positives in all aspects and I can’t say they provide any negatives whatsoever for me. People who may not get the opportunity to mix and make friends due to their mental illness get the chance to do so’. (4)

‘The groups have improved my confidence around people I did not know, reducing my anxiety and for that hour forgetting my problems. I now feel totally accepted by the group and have increased my friendship even at this early stage. During the group I have also noticed my negative thoughts seem to be far fewer.’ (5)

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Chapter 3: Give A Man A Fish

Deeper exploration was conducted in order to understand more about education, specifically in relation to informal learning opportunities as opposed to qualification-based learning. The strong correlation between the core purpose and the objectives underpinning ‘community learning and education’ was stark and the relevance and importance of forging closer links with this type of activity/recovery intervention became more obvious as did a need for closer connection with relevant services – for example adult and community education providers.

Expert adult and community education professionals confirmed that the purpose and objectives defined for community learning also hit many points of the Recovery Star. Community learning promotes and improves many aspects such as personal development, mental and physical health, social cohesion, maximises personal, social and economic well-being, encourages confidence and raises self-esteem. Many people undertake community learning activities for personal enjoyment and because they simply want to learn something new or re-engage in a previous interest. Individuals who participate in community learning form friendships and networks based on a common bond (in this case the reason they are participating is due to a common interest). This in turn leads to improvements around other unintended outcomes such as personal as well as community resilience. Evidence captured by the Family And Community Education Service from learners’ reasons for undertaking courses supports this.

The relationship with the Family And Community Education Service made evident the need for education recovery groups

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because they are relevant to basic human support needs. It also confirmed the thinking that from a very early stage, there were many similarities between nursing and teaching.

Furthermore, it cemented the joining of the two roads through a common denominator in both professions – ie Maslow’s Hierarchy of Needs.

‘the desire for self-fulfilment …….. the desire to become more and

more what one is, to become everything that one is capable of

becoming’ 3

Early indications on the project were that education can play an

integral part in developing the independence and confidence of

mental health service users ‘Give a man a fish and you feed him

for a day. Teach him to fish and you feed him for life’. (Anon)

When the opportunity arose in January 2015 for Adult Learning Providers to bid for funding in partnership with Mental Health (Recovery) Services to deliver a two-year Community Learning Mental Health research study, both authors wholeheartedly embraced this as the purpose of the funding was to ‘develop, deliver, evaluate and share educational approaches to support recovery from mental health conditions’. Knowsley was successful in its bid along with 60 other successful pilots nationally, hence the creation of a successful partnership and the joining of two roads.

Thankfully, this enabled FACE Forward to develop and the opportunity to further disseminate our work.

3 Maslow, A.H. (1943). ‘A Theory of Human Motivation’ Psychological Review

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Chapter 4: The Seed of Change

The following section in this chapter highlights barriers to learning, the blocks that individuals experience and the doors through which the barriers can be overcome.

Since the project commenced properly in June 2015, agencies, volunteers, participants, mental health experts and community education experts have been brought together to provide a quality of service never seen before in our area. Working this way with groups of participants also makes great financial sense with regards to the amount of participants seen at one time, with, for example reductions in expense claims for travelling time.

Following links with FACE, opportunities to participate in a range of informal community learning programmes and qualification-based courses were offered in response to choice. These opportunities included for example: English, Maths, ICT, Art, Floristry, Cake Decorating, Local and Family History, First Aid.

It was very quickly realised how important getting the right environment and surroundings were to allow participants, and the socially excluded, an opportunity to gain an education and qualifications that could help improve their recovery from long-standing mental health conditions which had created a multitude of barriers throughout life. Very often, these barriers have resulted in their basic human needs (Maslow) not being met. Many of these barriers stemmed from formative negative school experiences. This was a fundamental aspect of how we engaged with individuals, how they were initially interviewed for activities and how activities were designed.

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It was agreed that getting this Initial Advice and Guidance (IAG) right was going to be extremely important to the success of the project and to understand the support needs and barriers of our learners.

‘If a seed is planted in the desert and does not grow do we blame the seed? Or do we ask what we must change in the environment to help the seed to grow?’4

There is more detail about this ‘initial advice and guidance’ further in this chapter.

As groups progressed, so did many peer facilitators. A committee was formed comprising all group peer facilitators and a number of Third Sector agencies with whom partnerships had developed. The purpose of the committee is to ensure that each project or partner agency can interlink and refer to each other, thus vastly expanding the opportunities open to each participant and agency. The FACE Forward Recovery Network currently meets on a monthly basis with plans in place to develop the meeting into a monthly drop-in with an open door policy for all participants. Participants and professionals are able to call in and access numerous services with ease.

Six volunteers who were facilitating groups progressed to complete an NCFE Level 3 Award in Education and Training, a qualification which enables them to enter into the post-16 adult and further education sector. Peers were crucial in supporting others through groups and classes due to their own similar past

4 Deegan, P.E. (1996). Recovery as a Journey of the Heart. Psychiatric Rehabilitation Journal 19, 3, p.91-97

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experiences. This clearly helped and was reassuring to the participants.

To witness the recovery journey of individuals who began FACE Forward as a participant in secondary services and who continued throughout and then beyond the project as qualified teachers, was humbling and a privilege to be a part of. Apart from the obvious benefits of having these amazing individuals on our project, there were other less obvious benefits as well as unintended positive outcomes.

At the time of writing, FACE Forward Year 1 had 20 active volunteers who were working on a range of groups and activities such as football/ badminton/ gardening and walking groups and who were also involved in the co-production/ facilitation of a number of the education courses. This has helped to change the culture of the service and help professionals adapt to working alongside participants, to aim for mutually agreed goals, as opposed to the historical hierarchical nurse/doctor/participant relationships.

Upwards of 175 individuals participated in over 500 activities in Year 1 of the FACE Forward study. Every individual was measured at the beginning, in the middle and at the end of their activities using mandatory assessments for Depression (PHQ-9), Anxiety (GAD-7) and Well-Being (WEMWBS5). These assessments were a requirement of the project in order for external evaluators to gather quantitative data and seek to measure the impact of ‘learning/education on recovery’.

5 Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) © NHS Health Scotland, University of Warwick and University of Edinburgh, 2006, all rights reserved

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It was apparent at the very beginning, from a FACE Forward perspective, that these quantitative assessment measures did not evaluate or measure a lot of the improvements witnessed. Interestingly, but not surprisingly, these assessment tools weren’t received very favourably as participants complained of ‘too much paperwork’ and again having their ‘mental health issues a focus of attention’ when actually they had come to participate in ‘non mental health activity’. Attempting to quantify emotion, feeling, mood, well-being, thoughts etc cannot be achieved by a number, so the project leads developed other more qualitative methods in order to evaluate the impact of ‘learning on recovery’ by joining experience from both the education as well as mental health worlds with the focus very much on learning, independence and self management.

Given the feedback from participants, it is important to recognise that the mandatory anxiety, depression and well-being assessments alone do not provide an accurate evaluation of the true impact FACE Forward has had on people’s lives. For this reason, individuals were asked to write about ‘personal stories’ of the project and how it aided their recovery which they were very happy to provide. After all, an individual could have thousands of pounds spent on mental health therapies/medical interventions and medication but if they don’t ‘learn’ from their experience of these interventions, then the cost of these interventions is wasted and there is no ‘change’ from either the public purse or for the individual.

Ironically one of the main reasons that these ‘recovery through education’ interventions works is because at times the interventions are actually nothing to do with mental health! The art class promotes drawing, the creative writing class provides

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an opportunity to write and read – both serving to facilitate the development of creativity and imagination. In all group activities, people are allowed to concentrate and think of things other than their illness or problems.

Participants were encouraged to look and plan towards the future (Individual Learning Plans) rather than dwell on or keep analysing the past.

Feedback from participants was that they often get tired of being asked the same questions about their mental health or mood by professionals. The classes/groups allowed them to be considered as a person first, and not defined by their mental health condition or diagnosis.

Nicola’s Story is a personal account of engaging in a learning activity in order to distract herself from her negative thoughts.

‘Starting on the FACE Forward creative craft/ floristry course has brightened my life. Our tutor has helped and taught me a lot. I have done floristry and creative skills before however I have never been able to complete my courses or qualifications for one reason or another. The FACE Forward floristry and creative skills is a really good course and it has helped me to feel comfortable in a group of people. It is a really friendly group and our tutor is so supportive. I started the course late and I was able not just to refresh my skills but I have had a chance to achieve the NCFE Level 1 Award in Creative Craft. I had waited a long time to train back my skills. I did not know that if I was given the chance I would be able to consistently turn up and produce good work. Until now my past has held me back and felt as though I have had a dark life and not wanted a future and as if I wanted to die.

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But now instead of having 7 bad days a week I have 6 bad days and one good full day. That is the day in my class with Carol and the girls, and this gives me a really happy feeling as I leave my issues at the door and for the enjoyment and education. Thanks to whoever started FACE Forward for us with mental health problems as it has helped me loads and my confidence is a lot better and I am not as nervous as before. I love it.’ (Nicola, 2016)

Being exposed to a structure of learning helps some individuals undergoing psychological interventions to begin to apply this learning structure to therapy. For some, this approach empowers them in their own recovery journey. They start setting their own recovery tasks/targets from which they can evaluate and measure progress and distance travelled. They become their own recovery educators. They are not having something ‘done to them’, rather they are or have a sense of being ‘in control of’ their own recovery process.

Psychological therapy can be beneficial for some, but for others, analysis and exploration of their condition is often a traumatic experience. It is due to these traumas that when a person is referred for psychological therapy, they should also be offered psychosocial interventions (such as recovery through education) as detailed in this book as a valuable and much needed distraction and alternative means of support.

Community Education providers such as FACE are measured through successful achievements in learning. For learning to be successful, an individual has to have an interest in what they want to learn about, be motivated, be encouraged, engage and stay engaged, understand and be able to recall, apply, transfer

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and demonstrate this learning in later situations. The effectiveness of a ‘teacher/mentor’ is pivotal within this process. Learning is knowing something or being able to do something not known before, resulting in a changed behaviour or thinking.

People who can read are educated and are privileged in that they are able to learn and will continue to have an ability to learn because they have experienced learning at some point through positive teaching and learning experiences.

‘Reading is important, because if you can read you can learn anything and everything about anything’ (Tomie dePaola)6.

At some point, this learning will result in a change of behaviour or thinking. However, lack of education for whatever reason or negative educational experiences, limit exposure to and desire for learning – be this intrinsic or extrinsic, resulting in limited or no change in behaviour/thinking. This limited exposure could be due to class, lack of home or public access to books or possibly due to no culture of reading and therefore writing.

‘If we do what we’ve always done, we will get what we always got’ - if we continue not being able to read, we will continue limiting our ability to learn and there will be limited change. For learning to be truly inclusive and effective – teachers/tutors ask themselves ‘can I teach they way individuals learn’ and not expect participants to ‘learn the way I teach’. If we can learn, we can learn about ‘change’ or ‘how to do things differently’. Learning allows us the opportunity to open our minds. Open minds absorb learning.

6 https://www.youtube.com/watch?v=7epT0qUaaX4, 12/4/2010

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The following two powerful accounts demonstrate how lives can be truly transformed as a result of a ‘learning opportunity’ linked also to a previously held interest and through the effectiveness of teaching/learning, significant gains are made.

Wendy’s story is a personal account of lacking confidence to pursue a previously held interest due to a present mental health condition. FACE Forward provided an opportunity for Wendy to engage in a safe and supportive environment.

’I first learnt about the creative craft course from my daughter who attends the Huyton information centre for art on the Thursday morning. I was very low and depressed with the grief of losing my brother in April 2015 and in October I took my daughter’s advice and joined a floristry class. The course has taught me so much but has also helped me gain my confidence among people. In our class there are people who have similar troubles to myself however we all seem to focus on the class rather than our problems for the time we are there. I have always been interested in floristry and would love to be able to gain employment one day from the qualifications I have gained with FACE Forward. In February 2016, we had a presentation day where each person received a certificate for their course work and also there was a video shown of people expressing their feelings about how much the FACE Forward courses have improved their confidence. I myself have recently gained the confidence to go on to do NCFE and the internal verifier has marked and commented on how well I have progressed since joining the course.’ Wendy, 2016)

Being open to learning eases the transition through change as we are then open to wanting to change (i.e. we create the desire

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intrinsically to want to do things differently). We can’t necessarily ‘unlearn’ but with positive and supportive teaching to reinforce learning, we can be taught how to ‘relearn’ and apply new learning because if we don’t then ‘If we do what we’ve always done, we will get what we always got’.

Applying this ‘learning’ to recovery is partly about ‘teaching’ individuals to ‘learn’ about and for themselves and in turn learning about and think for themselves. If we don’t know how to learn at all or we have had limited exposure to learning or previous negative education experiences, one question to consider is will there ever be any change? Another reason behind this question is there may not be the intrinsic desire to want to learn or know how to do things differently despite all the extrinsic stimuli. The effectiveness of teaching strongly impacts on our ability to learn and as a result change. We have to learn how to learn before we can learn how to change. Although by definition the term change means we are ‘constantly’ looking to do things differently, one of the many ‘constants’ in life is ‘change’. Learning to accept this is key to embracing any aspect of change and thus developing the intrinsic desire to ‘want to do things differently’ and ultimately wanting to ‘learn’.

Barbara’s story is a personal account of how providing a positive and supportive learning environment enables participants to apply learning to recovery.

‘Attending the art class has made me feel a lot better as I know I am mixing with people I can trust. I really enjoyed receiving my certificate and this was a great boost to my confidence. It has made me realise that other people also have problems, not just

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myself, and it makes me feel good to be able to support others and help lift their spirits and help them to get back on the right track again. I feel that I learn something new every week at the class and this is a great bonus and that the tutor Liz always makes us feel very comfortable and treat us all as equals. We have made some excellent creative work which helps to make you think. Alex and Barbara have done a wonderful job putting these classes together and they really help us all with our mental health issues. We also enjoy guests and students such as Faye from Liverpool University coming to our group to see the excellent work being produced and hopefully spread the word. I just wish they could all stay with us!’ (Barbara, 2016)

It was crucial that FACE Forward Leads worked closely with participants to ensure they were not fearful of embarking on a learning activity, that they felt safe, secure and comfortable to share any fears, worries/concerns or barriers they may have as a result of any previous negative experiences. FACE Forward Leads devised a simple initial survey ‘School’s Out for Summer’ aimed at encouraging individuals to reflect on their previous and earliest education memories.

The introduction to the survey focused on the purpose of asking participants to complete as honestly as possible. Returning to learning after a long period out of education can be a daunting and frightening experience. For many adults there are good and not so good memories from school days and these not so good memories often present barriers for the future and for the present especially where there may be a deep desire to learn but also a deep rooted fear. Holiday time (School’s Out for Summer) can be a positive experience for some but a lonely, isolating experience for others. Participants can be encouraged to think

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that with suitable support, advice, guidance and teaching, they will overcome personal barriers due to negative early experiences, and will grow and develop in confidence.

Liz’s story is a personal account of how returning to learning can be a frightening and daunting experience:

‘I think the FACE Forward project is a great project and is something that has been needed for a long time. The 5 Boroughs Partnership and FACE Forward tutors have a lot of feeling and understanding for the pupils. Dave the tutor also knows we have had mental health problems and he has time for us and treats us all with respect and passes no judgement on any of us. When I went to the first lesson I was so afraid and felt as if I wanted to go home. The first papers to come around were little skills checker tests. Immediately my confidence drained and a lot of negative feelings and experiences of school came flooding back to me and I felt I was not capable completing the test. I left school with no qualifications at an early age as I felt the teachers gave their favourite pupils all the help and the rest of us were shoved to one side. My negative thoughts and mental health were getting the better of me. Dave the tutor noticed that myself and another girl were struggling and he came over to us. I explained to him that me and the lady had mental health problems and I feel as if I can’t do this and it is not for me and I would not be coming back next week. Dave reassured us but I was struggling with my mental health and my anxiety levels had risen and confidence was out of the window. As I left at the end of class I remember thinking that there was no way I would be back next week as the work was way too hard for me. As I left the classroom the tutor Dave took time out to chat to me alone

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and gave me some reassurance and convinced me to give it another go and come back the following week for one more try.

During the week I also spoke to an occupational therapist from the recovery team called Lisa and Lisa informed me that she would be coming on the course and also encouraged me to give it one more go. I agreed to give it one more go and come back the following week and I have to say that I am so glad that I did and that I took Dave’s advice as I went on to make some great friends in the class with both participants and professionals and we had a great laugh during the course. Lisa sat by me every week and we helped one another with the course and both did a talk in front of the group together. Ironically there were times when it was actually me supporting Lisa as she had got a little nervous. This gave me great confidence.

On reflection I feel that my early negative experiences of education had come back to haunt me on that first day back in the classroom and if it was not for the support of my peers and the FACE Forward tutor I would not have stayed on the course. As it is I finished the course and completed over and above what was required in coursework and was always the first to have my work completed. Finishing this course has instilled in me an inner confidence as I have proved to myself that I can achieve what for years I thought I could not. Who knows what I would have been today had I have been given the correct support all those years ago!?

The returning to education part has also meant a lot to me as it has given me a chance to prove that I am not a loser in life. It is a measure of how my confidence has improved in meetings as before I would go to a meeting and think of things to say but be

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reluctant or too nervous to bring them up as I was afraid to speak in front of a big group of people. That is not the case now and if I think I have to say something then I do and actually at times can be quite outspoken.

I now facilitate my own art group on a weekly basis and love doing this and speaking up and fighting for the rights of our group. It is great to see the members of my class grow in confidence from week to week just as I did on the education and training course. I believe I have caught the bug for education and have enrolled on a mentoring course and hope to start my Level 4 in Education and Training in September.

I really hope that these groups continue as I truly believe they save the NHS a lot of money. Our group has given its participants a whole new lease of life as they are mixing every week and meeting new friends. You can see people’s confidence growing each week and most openly admit that it gives them something to live and get out of bed for. They love the group that much that when it is time to go they do not want to leave. All I can say now is well done Alec from 5 Boroughs partnership NHS and Barbara from FACE Forward. This has been a really big success and we hope it goes on for many years to come.’ (Liz, 2016)

There are many surveys, questionnaires and assessments we are asked to complete at different times and for different reasons, but very rarely are we asked about our earliest school experience(s) or if these experiences affect our self-actualising needs (as identified by Maslow). The questions in the School’s Out for Summer questionnaire were aimed at encouraging individuals to be as honest as possible about previous educational experiences. Responses have helped the service to

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support and guide individuals in the best way in order to help them achieve their own learning potential. This correlates directly with Maslow’s Hierarchy of Needs. Feedback from participants underpins the very essence of why FACE Forward activities are important. Findings show:

Over 50% of participants rated their current academic skills based on school achievements as average or poor, just over a third said good and 0% said excellent.

Over 40% of participants left school without any formal qualifications.

Around 50% of participants felt their early years’ experience of school had affected them on their return to adult education.

Over 60% said their early experiences, positive or negative, had a direct effect on their own life coping mechanisms and mental health in adult years. 22% were unsure and only 13% responded ‘none’.

85% of participants recalled consistent comments made by teachers on school reports (the majority of comments were not encouraging or developmental. For example, one participant recalled being told ‘don’t aim too high – you will only amount to shop work’.

65% of participants were told to try harder yet they believed they had tried their very hardest/best. This impacted significantly on levels of confidence and the following are quotes from participants as to how this made them feel:

o Stupid o Would not want to continue o Managed to get lost in class

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o Frustrated o Got 97% once and got asked ‘where’s the other 3%’. I

felt demoralised o Hits your confidence o Bad tempered o Embarrassed and nervous o Was told this all the time o I couldn’t do anymore o Nobody actually sat down and helped me o Upset because I would be doing my hardest

When asked what made their experience of school positive o 33% enjoyed learning o 20% enjoyed the social aspect o 27% felt good teaching o 16% to escape the home environment o 4% said something else

When asked what made their experience of school negative o 25% poor teaching o 15% poor environment o 23% were bullied by peers o 10% problems at home o 27% said something else

When asked what participants felt made a good teacher, the two top qualities stated were ‘listening’, ‘patience’, ‘understanding’

It is evident from findings that individual needs were not being met and for some, these needs have continued to be unmet and have affected confidence and self-esteem throughout life. Having said that, some enjoyed learning but other negative experiences from school held them back. A significant

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‘something else’ factor was ‘taking exams’ and the ‘fear of exams’ and those individuals became closed to learning. Is there a connection here with being tested and challenged (ie the connection related to taking exams/fear of exams) that remains a barrier for other experiences in later life? Is the fear of potentially not knowing something/being tested greater than the fear of engaging in something which limits our ability to learn and change? In other words, the fear of exams in earlier life stifles the intrinsic desire to learn. For those in therapeutic interventions aimed at improving anxiety, depression, well-being - is the fear of potentially being tested/challenged about oneself connected with an educational fear of being tested resulting in therapeutic interventions aimed at improving depression/anxiety not being wholly effective, and therefore, why recovery through education activities such as FACE Forward are proving beneficial.

If we cannot learn or are closed to learning, then change becomes limited and our behaviours are unlikely to develop. Maybe there is learning for both experts in recovery and also in education. A changed behaviour is a positive outcome of effective teaching and learning as well as what successful recovery is seeking to achieve. Not all medical experts/professionals are effective teachers, hence for some participants, learning will not happen, changed behaviour will not result and participants remain in a cycle of medical interventions.

Repeatedly offering participants medication and therapy from the first point of contact can also lead the participant to believe that these are the only treatments for successful recovery. This can result in participants repeatedly looking to these treatments

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for answers thus creating dependence and a reliance on services/ medication. In our experience on the project, changing the mindset of participants has been one of our biggest challenges. However, when participants are given ownership of their own recovery at the earliest stage by providing an array of recovery options, progress is made much more quickly.

The following participant accounts demonstrate how the effectiveness of teaching underpins effective learning resulting in changed thinking and behaviour.

ANON

‘I have enjoyed every day I am at my FACE Forward course. It has been so rewarding learning new skills I never thought I could. Being around other people and chatting and making friends. I no longer feel so isolated and always look forward to the days I attend the course. I do not want it to finish as I love every minute. My anxiety levels are so much better than before and my confidence is so much higher.’ (2016)

Julie Anne’s story

‘At first I wasn’t sure about attending a new class as I lacked in confidence. Eventually, as the teacher taught me what to do, I began to feel at ease and as the weeks went by I learnt so many new skills. I am now more relaxed at home knowing I have the ability to make beautiful creations and it helps keep my mind active. It has definitely brought me confidence in my style and I can now express my happy feelings through gorgeous flowers. I also have the added bonus of finding a new group of friends that I did not have before and would love these courses to continue.’ (Julie-Anne, 2016)

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Dave’s story

’There have been times that I have attended the art class where I have felt really down however I have made the effort to attend as I know I have a really close group of friends there who support me at these times and stop me from feeling down. Liz the tutor is extremely supportive and friendly and my mental health has improved a lot as a result. Sometimes the group can have a sing song and I feel confident enough to be the main singer as I know I have the support of the entire group and will not be judged. I really enjoyed the experience of going up on stage with all my new friends to pick up my certificate. The FACE Forward art course has improved my confidence a great deal.’ (Dave, 2016)

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Chapter 5: 10,000 Kicks

Any new or alternative road may not be finished until it has first been tried and any bumps have been smoothed over. Remember back to the story of Bob in Chapter 1. For this new/alternative road versus the original cobbled pathway, there remain challenges which become the ‘maybes’.

Maybe for some individuals in recovery services, there may never be a change in behaviour or thinking because the cycle of current recovery interventions that an individual finds themselves in do not offer ‘learning opportunities’. If medical practitioners with a responsibility to support individuals through recovery continue not to realise this then the situation summed up in ‘if we do what we’ve always done, we will get what we always got’ will continue to apply.

Maybe the approach to medical recovery continues to be similar to old ways of education thinking (‘I expect participants to learn the way I teach’) where the position of power is in the hands more of the medical practitioner/teacher rather than the participant.

Maybe a more inclusive and effective approach could be modelled around the participant (‘can I teach the way you learn’), which encourages the experts to ‘change’ their behaviour to the needs of the individual. This approach serves to shift the balance of power, creating more equity of give/take, support/expectations, empowers the individual and creates a sense of shared ownership/responsibility to ‘do’ things differently rather than a continued state of ‘if we do what we always do, we will get what we always got’.

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Maybe medical interventions place individuals in positions where any power or control of a person (self) is explicitly placed in the hands of others ‘who know best’. When some individuals don’t fully respond in the way expected (‘I expect participants to learn the way I teach’), is this wholly down to the limitations of the individual or to the limited approach of the expert?

Maybe some individuals view/perceive changes as something that has to be ‘done’ or something that is being ‘done to them’. If the focus becomes ‘learning how to do things differently’, then a shift away from ‘experts who know best’ can be achieved. The word ‘change’ becomes a ‘learning activity’ and instead of focusing on ‘having to DO something’, individuals focus on ‘learning HOW to do things differently’ and things they enjoy. Participants also get to choose what they want to do which provides personalisation, choice and hope.

Maybe individuals in recovery have developed their own ways of ‘learning’ from their own personal negative experiences. Some may have learned how not to do things to avoid continued negative experiences and ‘learning how not to’ rather than ‘learning how to’ becomes the basis of their approach for all future forms of learning. So can individuals learn from positive changes in environment and more positive social circles they experience in Adult Education? If there is limited learning there will be limited changed behaviour, thinking and progress. Learning conflict and confusion may be paramount in their thinking and maybe the teachers, mentors, role models in trusted positions to teach didn’t uphold the key principles of

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effective teaching resulting in this mistrust of learning and a negative experience (‘do as I say, not as I do’).

Maybe individuals can ‘relearn’ but many view learning as being complicated or ‘I can’t do this’. All forms of learning can be broken down into simple sequential stages AND sustained through reinforced teaching and learning at each stage. Take disciplines such as Martial Arts where the focus is much practised techniques along with the how and why. Bruce Lee once said ‘I fear not the man who has practised 10,000 kicks once but the man who has practised one kick 10,000 times’. This repeated reinforced learning changes mind-sets and improves confidence, self-esteem and feelings of self-worth. This changed behaviour becomes an intrinsic way of life.

Learning is for life, however, there is often a time limit for those being supported through recovery with therapeutic interventions, hence the absolute value of user led peer support groups and community learning opportunities which provide individuals with access to safe spaces where they can ‘practise, practise, practise’ their learning to result in a changed behaviour.

Any reinforced learning that is repetitive in nature and results in changed behaviour, can over time, develop this changed behaviour into the norm regardless of the type of activity. The process of ‘practising learning’ becomes a discipline in itself and can lead to long-term changed behaviour – the result being lifelong learning.

Of course group activities or education may not be suitable for everyone. However, almost everyone does have personal

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interests of some sort and for many mental health professionals, a large part of Recovery is to offer participants opportunities to develop and build on those interests as part of their recovery. This also greatly enhances engagement with services and reduces ‘DNA - do not attend’ rates. Recovery has to be personalised and individual.

Often, mental health professionals are restricted by their limited options because they do not have a lot of other options open to them and struggle to think outside of the medical model. This is certainly the case thinking back to Bob’s situation discussed earlier in Chapter 1 of this book.

Education, peer support, activity or exercise groups are not currently common features of mental health services. Funding is not provided to support teams and individual staff in developing these recovery options. Our evidence supports a holistic approach which brings together a broader combination of medication and therapy alongside educational and social inclusion options and opportunities.

The following two stories show how learning can aid recovery.

Dawn’s story

‘My experience of FACE Forward has been wonderful and it has given me the chance to meet new people and learn something I never thought I would be able to do. I really look forward to Fridays and getting out and it makes me feel so much better about myself and what I have created. It makes me feel really good and I have now become friends with the people from the class. I wasn’t very confident when I first started but week by

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week my confidence has grown and I now look forward to attending every week.’ (Dawn, 2016)

Sarah’s story

‘The creative art and writing class has helped give me more of a focus on what I’d like to do in life, present and future. It has given me something to get out of bed for and more of a platform for me to express myself creatively. It is helping to boost my confidence in interacting interpersonally and creatively. I am realising new qualities in my personality, which is also helping to piece myself together as a person in aiding my recovery.’ (Sarah, 2016)

In the world of community learning, there is much proven evidence measuring the impacts of adult learning on different areas in life, most importantly health, employment, social relationships and voluntary work. Research has also been conducted which attaches a monetary value on the degree of impact linked also to life satisfaction and well-being. The monetary value of the effect of adult learning is much higher for those who participate in learning if they have mental health issues and are in primary/secondary services although this participation in learning can save money further down the line especially if individuals progress to being discharged as many of our participants have. It costs the NHS approximately £32 for someone to step into a GP surgery, approximately £111 to call NHS 111, approximately £124 for someone to visit Accident and Emergency and almost £250 to call an ambulance. Not even stated here are the costs for issuing prescriptions for medication, referral letters, appointments with Psychologists or Psychiatrists or other Mental Health practitioners.

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If there is evidence that participating in learning impacts positively on health and well-being, we have to see health (whether physical or mental), as well as learning as a continuum. A person in good health is able to communicate and work effectively, sustain positive relationships and build good social networks. Individuals may move up and down as well as along the continuums depending on their sense of well-being rather than their actual state of health. If well-being needs are met, then health is good. A person in good health is least likely to be a cost to the NHS. Poor health has a negative impact on daily functioning, work and relationships and more likely to increase NHS expenditure.

Lynn’s story is an example of well-being needs being met

‘Since starting the FACE Forward project I have felt a lot more confident and have many more friends than before. At the start of the programme I only enrolled on one subject (knitting) to try it out however I enjoyed this so much that I went on to enrol on a further 4 courses. It was one of the proudest moments in my life when I received my certificates for passing my courses at the participant graduation event. All the different tutors on the project are very friendly and supportive of all the participants and help us through on the days where we might not feel so good. The volunteers and the other participants are also very supportive of each other and we are like one big family. As a result of my improved confidence I have started to look after my appearance a lot more and eat a lot healthier and managed to lose 2 stone in weight. This has again boosted my confidence even further as people are now commenting on how well I look since I have lost the weight. Due to my weight loss I feel a lot more energetic and able to do more things of a day. I am also

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planning to go on walking trips which is something I have never done before.

These classes have made such a difference to my life and recovery that I feel it extremely important for them to carry on. In the past I have tried many different medications and therapies however none have been as beneficial and effective for my wellbeing than the FACE Forward educational courses.’(Lynn, 2016)

As found with FACE Forward participants who have experience of particular mental health conditions, the benefits can be even greater as the reliance on more traditional mental health services is reduced. The majority of participants on FACE Forward courses visited their doctors/nurses less frequently as their confidence grew and peer support developed.

The combined approach of FACE Forward leads, groups and community learning activities is proving to be more successful than some standard clinical approaches and is reducing the need for medication, yet this is an area of recovery that the NHS continually overlooks. The irony is that it can be provided by experts by experience, volunteers, community education professionals and Third Sector agencies. As FACE Forward Year 1 has proven - if a small investment is made then positive results can be achieved. Participant stories are testament to this project.

Iain’s story is a personal account of how a learning opportunity can deliver unyielding results.

‘My name is Iain and I am a volunteer for FACE Forward. I have recently been working on the FACE Forward Project where I have

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been working on the Local and Family History course. I have not been getting out of the house much for a while so attending this course was a big step for me however I have discovered through the course that I am capable of a lot of things that I didn’t think I was capable of!

Prior to the course I was not going out and mixing with people but now I find myself with a new group of friends and even see people I have met on the course now when I am out and about in Halewood and stop and chat to them. It has improved my social circles a lot and it makes me feel good to know that I have a lot more friends that I can talk too.

I have really enjoyed the returning to education and classroom work and this has led to me going out of the house more and actually getting the bus to Town to take pictures and videos of the old buildings that we are learning about in the class. I feel this is a great achievement because at one time I wasn’t even getting outside my house. Over the past 8 weeks I have been attending I can feel my confidence increase each week to the point where I am now going to Huyton on a Friday to help out with the local history class there too. It’s really good because I can now travel there alone on the bus without being worried or frightened and letting my condition get the better of me. I never thought it would be possible for me to get back to this stage of my recovery however since I have been doing the courses with Alan and Alex it has really helped me to move forward and I am really happy that I chose to come along and attend the FACE Forward course.’ (Iain, 2016)

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Chapter 6: Starting Over – A Road to New Beginnings

This chapter is about 2 inspiring individuals and their stories about their remarkable journeys of recovery through education, peer support and volunteering.

‘My own personal recovery journey began in 2012 when I became severely mentally unwell due to many negative past experiences and relationships in my life. It was at this point in my life that I realised I had to focus on myself and my mental health, without really knowing how or where to do this!

I was a patient with Knowsley Recovery team however on reflection I now realise that at the point of discharge although I had made progress I was far from recovered. It was at this point that I met with Alex who introduced me to FACE Forward and all of the opportunities they had on offer.

The first group I attended was an Arts and Crafts group on a Friday afternoon. The group was so friendly and vibrant and straight away I was made welcome by my peers. During discussions with fellow group members I found out about other courses including a Dual Diagnosis group for mental health participants suffering from addiction. I was then extremely keen to attend this group and help others to pass on my own personal life experience.

I was introduced to one of the group facilitators - Dave and the volunteer experts by experience who had suffered from, but overcame addiction in the past. I soon became a volunteer and enrolled on FACE Forward courses in Education and Training and also Mentoring to equip me with the skills to be able to plan and structure group sessions and provide peer support.

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Through these courses I grew as a person which raised my confidence and self-esteem to the point where I was ready and able to facilitate a group session alone. I remember thinking at the time of how far I had come and how 18 months ago I would never have believed I could do this but here I was.

By now I had the education ‘bug’ and had also enrolled on an English course and the subject I had feared all my life - Maths! I had always struggled with this subject, however, the FACE Forward tutor Michelle was amazing and extremely understanding and applied no pressure on me. I now had the confidence and belief to follow my own personal dream I have had for many years which was to set up a women’s self-help support group in Knowsley.

Myself and my friend, who has experience of mental health, then produced a constitution for a group called ‘The Women’s Room’. We have a strong support network of many agencies including the NHS, through Alex, as well as the Local Council. We received our first referral through FACE Forward! I can honestly say that without the opportunities and encouragement from FACE Forward I would never have had the skills or confidence to get to where I am today. The education courses and the support groups I have attended and supported gave me the strength and knowledge to be able to manage my own mental health symptoms and become the person I am today. One who is confident in herself and no longer feels a failure or scared to challenge herself.

I will continue to recommend FACE Forward courses to others in the hope that they too can realise their dreams as I have. (Michelle, 2016)

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Jay’s story is a powerful example of how open minds can absorb learning:

’Hi my name is Jay. I am now a volunteer for FACE Forward and 5BP. I didn’t really do much at school as it was difficult as I was moved around 4 different senior high schools so schooling wasn’t schooling and I tended to avoid going in or I would find it hard to engage or always sit at the back of the class as I never had the confidence to put myself forward.

At my lowest point I had turned to alcohol to combat my depression and had continued to alienate my wife and children through drink as they did not know how to help me. I had lost everything and at this time did not know where to turn for help. I had stopped drinking but did not know what I needed to do to improve my self-esteem and confidence which by now was at an all-time low. It was at this point in my recovery journey I learned about the FACE Forward project. The project has helped me massively and the amount of courses on offer is fantastic. I have suffered with depression for a while so I would not mix with people but coming to the classes has helped me meet new people and make new friends. Now I will sit at the front of the class and I am confident to not only answer questions but also support other participants who may be new or struggling a little with their work. Whilst I have been involved with FACE Forward I have done my Teaching and Training Level 3 Course, my Diploma in Health and Social Care Level 3, my Level 1 Maths, currently waiting for Level 2 exam, and have just started my English Level 2. I have also been involved in a Local History and Family Tree class which I have helped facilitate. My mental health has improved massively because of these education courses and I believe they have been the main part of my recovery and at the

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moment I feel like a sponge and just want to learn. I feel I missed out on all this when I was younger and it gives me great confidence to prove to myself that I can actually do it. There are so many courses on offer with FACE Forward I wish I could do more but there are not enough hours in the day! To me education has been the one main thing that has helped me through my recovery. Whilst I look forward to my courses each week I also look forward to seeing the people I am on the courses with. After the courses have ended we have stayed in touch and we are also forming other groups from this such as education support groups for people attending the courses. My confidence has improved greatly due to this. Looking back I realise now I have always had very little confidence and self-esteem however now people can see how confident I feel and often come to me for advice and support which is what I enjoy doing. This is why I have organised and facilitated certain groups. I have also realised that being able to help other people who may be at the stage where I was a couple of years ago is what helps me through my recovery. For this reason I have recently started my own peer support recovery groups and classes and have officially formed my own local community group called ‘Starting Over’.

I am hoping that through starting over I will be able to continue to help others in my local community through education and peer support in the same way that FACE Forward helped me through mine. After all, not only did education improve my confidence and self-esteem, it went a long way to helping me win my self-respect and family back.’ (Jay, 2016)

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Lisa’s story is one of a lady, who following being made redundant due to ill physical health in her previous line of work, became very depressed and isolated herself.

‘I had to medically retire from a very good physical job due to physical ill health. This left me very depressed and frustrated and having to battle every day with health and financial struggles. When you are in constant pain and tiredness it is easy to just sit in the house and do nothing. The FACE Forward course has made me want to get out of the house as it is very enjoyable. I go into my own little world and feel very relaxed. The teacher is lovely with a very calming manner and the other members of the class are very friendly and we have a laugh.

I am now doing my Level 3 Education and Training Award and I will be looking to use my jewellery making skills in my teaching because I would love to teach art and crafts. I am really hoping the course carries on a Tuesday as it is something to look forward to.’ (Lisa, 2016)

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Chapter 7: Professional Perspectives

Expert: Alec Horrocks, Senior Mental Health Practitioner and Non-Medical Prescriber, Knowsley Recovery Team, 5 Boroughs Partnership NHS Trust, (FACE Forward Project Lead)

‘During my time working in the field of mental health, I have always felt as though educational courses were only considered any use or achievable by people who had ‘recovered’ or who were a long way down their recovery path. However, my experience on the FACE Forward project has led me to change my opinion and realise that I was wrong. Previously, I had never witnessed “education” being offered as part of anyone’s recovery plan. Throughout FACE Forward I have seen people who have struggled for a number of years with their mental health issues and been largely resistant to medication and therapies, embrace the world of education and all that it brings. Education builds on people’s confidence and self-esteem by putting the person first and not focussing on their mental health symptoms.

Adult education in particular brings together like minded people who, for whatever reason, may not have achieved to their full potential in their formative years.

In my experience this often helps the classes to bond as a common goal unites and people with similar negative experiences of education in school years, support each other through courses to achieve lifelong goals.

Feedback from learners throughout the first year consistently informed us that the reason people felt it worked for them was

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because courses were not actually focussing on people’s mental health symptoms or problems but allowing them an opportunity to learn, develop and educate themselves on their chosen topics.

From experience I have witnessed that people are more motivated to engage in a subject that they hold an interest in.

Adult education provides a vital opportunity for social inclusion, which leads to peer support and friendship, also leading to increased confidence and self-esteem and in turn impacts on well-being and makes people feel part of the community again.

It is the experience of the past 12 months and the witnessing of some of the remarkable recovery stories detailed in this book, that I now firmly believe education has a large part to play in people’s well-being and recovery and should be a commonplace in mental health services across the country.’

Expert: John Ashcroft, Consultant Psychiatrist, Knowsley Recovery Team, 5 Boroughs Partnership NHS Trust

‘I began working at Knowsley in January 2016 and have found that being able to refer participants to an organised education and social inclusion programme extremely beneficial. Rather than simply making suggestions regarding lifestyle change, having a formalised programme is of huge benefit in terms of motivating participants to change negative aspects of their lifestyle and develop new skills. The programme also allows for speedy access to alternative and complementary therapeutic options for participants with adverse side effects of medication, treatment resistance, and/or physical health problems.

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I have referred many participants through to the recovery college and I have received excellent feedback both of the courses offered and the quality of the staff involved in the delivery.’

Expert: Dr James Whalley, Psychiatrist, Knowsley Recovery Team, 5 Boroughs Partnership NHS Trust

‘I have worked within Knowsley Recovery Team since December 2012. Part of the recovery ethos is giving participants the confidence they can regain control over their mental disorder to become useful members of society and to not feel a sense of social isolation. In promoting this ethos the setting up of the Recovery College and FACE Forward programme has been invaluable. Alex Horrocks has attended my outpatient clinics during the last 12 months to offer these services to individuals nearing the point of transfer back to their GP. I have seen at first hand the confidence participants have gained by accessing the various groups offered within the FACE Forward programme and in my opinion this has definitely enhanced their recovery.’

Expert: Dr Gina Smith, Clinical Psychologist, Knowsley Recovery Team, 5 Boroughs Partnership NHS Trust

‘Social interaction, participation in meaningful activities and cognitive stimulation are important aspects of recovery in mental health, indeed in all of our well-being. Unfortunately people who use mental health services often struggle to access these things due to the stigma and the barriers mental health problems can entail. This can maintain or exacerbate symptoms and stop people achieving the recovery they want and

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deserve. FACE Forward offers a solution to this as it is somewhere people can access these things so vital to their recovery. ‘

Expert: Jo Telfor-Smith, Accredited Cognitive Behaviour Therapist, Psychological Therapy Service, Knowsley Recovery Team, 5 Boroughs Partnership NHS Trust

‘I have had many cases of patients moving onto your service to consolidate the work they have completed in therapy. I guess the work you do can be encapsulated in one particular lady’s case. As you are aware she came to our service in a very anxious state and reluctant to engage in any group activity because of her lack of insight into her actual ability and potential. She accessed individual then group therapy and then with your support became an ‘expert by experience’ volunteer. As her confidence was nurtured by your individualised approach she began to attend a particular group and then eventually moved on to facilitate that group. With your guidance and support she then attended the teacher training course you offered and passed with flying colours. She is now discharged from mental health services and continues to facilitate and manage in terms of resources, the aforementioned group. This lady’s future has been changed and improved drastically by her involvement with FACE Forward.’

Expert: Chris Jones, Education and Performance Manager, Family And Community Education, Knowsley Council

‘The evidence provided in the case studies in this document would make it difficult to contest the positive impact of learning activities on the mental health and well-being of people with

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mild to moderate mental health problems. The people I’ve spoken to engaged in FACE Forward learning activities all stated that they are enjoying the fact that they are attending a regular group activity. Some also stated that their feelings of isolation had been lifted through their engagement and that their self-esteem had been raised by electing to take a more active and personal approach to their recovery. Moreover, people stated that the informal non-clinical course settings allowed them to learn in environments that were free from any potential stigmas associated with mental health problems. The non-medical mental health recovery intervention offered by FACE Forward provides an alternative solution for those who do not wish to follow a mental health services recovery pathway.

As with most people, I’ve had periods in my life where I’ve found it difficult to cope with physical or personal trauma. In my opinion, I found that during these times too much inactivity was detrimental to my mental health and well-being and as such I engaged in educational activities to occupy my mind and participate in new and interesting challenges. My educational activities and achievements during these troubled times inspired me to continue further with my education, accept life changes, and pursue a very different vocation by gaining a teaching qualification. As such, I admire greatly the commitment of those who are actively engaged in FACE Forward activities and I’m positive that they’ll benefit significantly through their participation in education, as I did.

In my opinion, the ethos of recovery through education instilled by FACE Forward should not be viewed as a short fix for those suffering with mental health problems. Education is a lifelong experience that empowers people to reach their full potential,

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and although life may throw up negative and exhausting personal challenges the challenges provided by education are extremely positive. As Leonardo Da Vinci quotes: ‘Learning never exhausts the mind’

Expert: Angie O’Neil, Head of Family And Community Education, Knowsley Council

‘I feel privileged and humbled to be working with so many individuals – participants, tutors, FACE colleagues, health professionals – every one of whom has a personal story and a personal journey. I honestly believe that every single one of us will have experienced, may be experiencing or will experience some form of mental health issue. I also believe that this experience actually makes us a better person with greater understanding of and better empathy for others. I believe that experiencing any mental health condition enhances intelligence, deepens insight, widens learning, develops greater tolerance and challenges prejudice. To truly understand and appreciate you need to truly experience. The Experts by Experience and Tutors who have been instrumental in teaching and supporting participants on this project since the beginning, are to be admired and commended for their unwavering involvement and commitment. Undoubtedly, their experience is helping others. It’s important to recognise their ongoing patience, support and skill in imparting their knowledge to others.

FACE Forward is about offering learning opportunities to those experiencing mild to moderate mental health difficulties. It’s about providing an opportunity to look ahead and experience learning on a road to recovery. For many, taking that first step is the hardest due to a multitude of barriers. A common massive

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barrier is engaging in a learning experience in the first place due to previous negative education experiences. Learning is for life and once previous negative experiences are broken down, whole new worlds and opportunities open up. Participants are real examples of how learning can improve confidence, self-esteem, knowledge, social relationships, self-worth and employment opportunities. All those who have participated so far are benefiting from their experience and their personal stories are highly emotive. Many things can be taken from us in life and very often we have no control over these things but no-one can ever take away achievements from learning/education. We all have a space in this world – sometimes we need to find that space, stand in it and own it! We may have to try a number of different techniques, therapies, interventions at least once but there will be one method that will click and this is what we need to focus on, practise and reinforce over and over again to change how we think and behave. I believe this technique is ‘learning’. We can become the masters of our own destiny, so we can stop being afraid of what can go wrong and start being excited about what can go right.’

Expert: Barbara Basnett, Internal Quality Assurance, (FACE Forward Project Lead), Family And Community Education, Knowsley Council

‘The FACE Forward Programme has supported a spectrum of people with mild to moderate mental health needs across various locations.

I feel privileged to engage with all people to support a variety of individual aspects to motivate and stimulate an interest to

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enable them to learn a new skill thus enabling them to mix and socialise with other people.

I have witnessed the FACE Forward learners develop throughout their recovery and it has been a joy to be a part of the project. Participants have socialised with fellow learners and peers and supported each other through courses to achieve amazing educational objectives and such a high quality of work which at times has exceeded that of their professional counterparts! All learning plans are devised collaboratively and individually with students to ensure they are on the correct path with sufficient streams of support in place should they be required.

I never thought of education as a means of mental health recovery, however, my experience during the first year of the project has left me in no doubt of the importance of this type of service in the community.

Expert: Michelle Daly, Essential Skills Officer, Family And Community Education, Knowsley Council

‘As an Essential Skills Officer for Knowsley FACE. I am supporting individuals, who are accessing programmes, through FACE Forward, that are developing and supporting adult learners and that are building confidence, raising self-esteem and supporting personal, creative and social development. The English and Maths classes help people meet the challenges of modern life and improve their employability and social skills. Learners are enjoying the classes and I can see the difference in individuals. At first some learners were really quiet and lacked self-confidence and belief. It is great to be in the fortunate position of seeing these people blossom, gain confidence and

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successfully complete their course and gain a qualification, which for some is the first ever achievement.

Expert: Sean Callow Walker, Senior Trainer for Knowsley Works, Knowsley Council and Tutor on FACE Forward, Family and Community Education, Knowsley Council

‘I have worked in education for over 20 years teaching various subjects centred on health and fitness, life skills, communication and personal development. One of my current roles involves working with post 16 year olds coaching them back into education and or employment.

In my experience, unemployment creates a multitude of conditions and circumstances that can cripple an individual’s personal development. With unemployment comes isolation, loss of purpose and responsibility, a reduction in confidence and self-esteem combined with a growth of pessimism for the future with nothing positive to aim for. The longer a person is out of work, the further away from being work ready they become.

In my experience, the jump from unemployment to employment requires carefully measured steps forward starting with increasing awareness of self. Exploring communication, relationships, negative verses positive thinking, developing mental, emotional and physical fitness are key first steps.

I developed an intervention for FACE Forward based on improving confidence and communication for individuals who have been out of work for several years. These topics address important issues such as:

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The value of communication and how to develop this primary skill

The importance of effective communication for the development of relationships across all areas of life including personal, work and social interactions

The effects of negative and positive relationships regards personal development and growth

Exploring how thinking affects emotions and how emotions affect behaviour

Signs and symptoms of poor mental, emotional and physical health

Methods for improving mental, emotional and physical health and fitness

The impact of practised and conditioned positive thinking and its subsequent effects on emotions and behaviour

Identifying ambitions and goals and embedding these destinations into SMART goals

Review and reflection of all topics explored, finding the courage to change and stay the course, embracing fear and anxiety as an opportunity and source of energy to grow confidence, esteem and opportunity

Education is the half way point to employment. Adult education is a choice. Choosing education that fits in with personal short to medium employment and life goals can create deep feelings of motivation and purpose which is nature’s own medicine for the recovery from despondency.’

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Expert: Dave Yates, Adult Education Tutor, Family And Community Education, Knowsley Council

‘I have been a tutor/trainer for many years working with a diverse range of groups and individuals across and range of subjects. I was asked to deliver a Level 3 accredited course in Education and Training to a group of individuals recovering from a range of mental health problems. This did not phase me one bit, so I got stuck into preparing and planning for the 20-week course which was to be delivered at a local academy school in the evening, once a week. What I wasn’t prepared for was the large number of learners on day 1 with a range of facial expressions from ‘let’s get going’ to pure fear and anxiety, particularly when I stated they would all have to plan their own lesson and deliver it to their peers. One lady left me with the impression, ‘I can’t do that, no way can I stand up and present to others’. She came back the following week and the next and the next and so on and achieved 100% attendance. The group dynamic was sometimes challenging but always rewarding resulting in 100% achievement. Give me groups like this anytime - their commitment, enthusiasm and desire to achieve was tremendous, a credit to their determination to overcome any barriers to learn and anxieties faced at the start. From my perspective, I feel everyone took on this opportunity in a positive manner not only to gain a valuable qualification but also continue to aid their recovery, build confidence and improve self-esteem. Several learners from the group went on to further training in mentoring and help deliver education with others working through mental health problems, this for me closes the ‘loop’ so to speak. Educating people to educate others, it was a pleasure to be involved.’

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Chapter 8: Facts and Figures

Engagement

In Year 1 of FACE Forward, 175 individuals participated in just over 500 learning activities – many of whom participated in more than one activity.

The majority of individuals who engaged in learning activities at the very beginning (June 2015), were still engaged at the end (July 2016) and are continuing onto other learning activities.

Participant Impacts

End of Year 1 evaluation statistics using the following set of agreed project impacts demonstrate how community learning hits many points of the Recovery Star.

Using a scale of:

1 = excellent/totally agree/extremely satisfied 2 = very good/really agree/very satisfied 3 = good/somewhat agree/more than satisfied 4 = ok/agree/satisfied 5 = poor/disagree/not satisfied 6 = not relevant or applicable to me Participants ranked the following in order of highest satisfaction to lowest satisfaction.

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Aspect Year 1 Rating

Year 2 %

The opportunity to participate in learning is important to me

1.5/6 Not asked

Learning is important to me 1.8/6 Not asked

I have been motivated to learn new things 1.9/6 100%

I enjoy things more 2.0/6 100% I am progressing onto another activity 2.3/6 97%

I feel my well-being has improved 2.4/6 100%

My mental health has improved and I can manage this better

2.5/6 97%

My living skills have improved 2.5/6 90%

I have better self-esteem 2.6/6 93% I am more hopeful and positive about the future 2.7/6 97%

I feel better able to take on and cope with responsibility

2.7/6 96%

I have better social networks and I’m involved in local activity

2.7/6 93%

I feel able to make better decisions about things 2.8/6 93%

My relationships have improved 3.0/6 96%

I am more trusting and hopeful 3.0/6 98% I feel more interested to move on or make plans for the future

3.0/6 97%

I have less addictive behaviour 4.6/6 100%

I have better work or prospects of work 5.0/6 90%

I have done something differently in my life that has changed things

Not asked

100%

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At the time of writing this Year 1 reflection, Year 2 is already underway and early analysis of FACE Forward Year 2 impacts demonstrate improved ratings against specific Recovery Star aspects.

Participant Comments from Year 1 Participant Impact evaluation:

‘I like to learn but I struggle with people’

‘I have been encouraged to learn new things’

‘I feel my well-being has improved’

‘I feel more confident’

‘I feel less isolated’

‘I have learned to socialise again and mix with different people’

‘I feel so much better about myself’

‘I always feel I am looking forward to something – it’s helped so much’

‘I have definitely been motivated to learn and to do the best I can’

‘My confidence is so much better’

‘I have achieved something that I am proud of’

‘I can cope better and am more responsible for what I do’

‘I loved learning new skills and feeling very motivated’

‘My confidence has grown so much I mix with people more’

‘It gives me something to look forward to’

‘I’m showing an interest in something’

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Conclusion

There is more realisation and recognition that developing relationships with partners and agencies improves participants’ experiences. These participants in turn also improve the experience of others with their own knowledge. This partnership working can alleviate pressure on an existing already stretched workforce as experts from different fields and disciplines work together in order to achieve a common goal rather than an approach of individuals trying to be ‘jack of all trades and master of none’.

In times of austerity it is understandable why services are reluctant to invest in ‘recovery through education/learning approaches’, however teaching participants self-management of their illness, and building their confidence, is a mutually beneficial solution for participants and for organisations with a vested interest. Often it seems that ‘recovery through learning’ interventions are looked upon as ‘the icing on the cake’ and not the ‘bread and butter’ of mental health care. However, in the author’s combined experience this is not the case. These interventions not only often work where medication and therapies don’t, but could, if used correctly, be used more as preventative measures that don’t seem to exist in most areas of mental health care.

The Social Return on Investment that projects such as FACE Forward can yield are far reaching. Such projects can provide much needed options and relief for heavily burdened mental health teams, nurses and support workers, providing education, social inclusion, physical health education and activities and a peer support that cannot be provided by professionals alone.

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The impact is more sustainable recovery and fewer burdens on services and the public purse. Rather than being viewed as an expense, working in this way can actually prove quite lucrative.

Many individuals often refuse to take prescribed medication, maybe because of side effects, or they may state they cannot continue with therapy as they find it too traumatic. However, participants are happy to engage in activities or subjects that they may have enjoyed at another stage in their life. In fact people from the football group for instance often state how playing brings back happy childhood memories!

Recovery can be a simple concept to achieve in a lot of cases and sometimes it can actually be services themselves that complicate the process of recovery for the individuals who are seeking simple yet effective support.

Recovery can also be as simple as having someone to talk to who truly understands your fears and worries because they have been there. Recovery can happen as a result of a shared experience by participating in old hobbies or sports with peers who will not judge or ridicule you, but will welcome you. Recovery can happen due to the fact that you have made a circle of friends with like-minded people all supporting each other to change lives and who you look forward to meeting every week, rather than friends you avoid as they don’t understand mental health. Very simple, recovery can happen as a result of a number of opportunities offered to people that provide them with hope for the future. The living hope provided by ‘recovered experts by experience’ proves recovery is possible. However, we need to make sure these opportunities are available because recovery

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should not be defined by diagnosis or rely on medication. It is defined by quality of life and setting/achieving life goals.

‘At my lowest point, I didn’t want to talk to anyone and tell them I felt suicidal. Through education I now realise I am capable of achieving goals I never thought possible’ (Iain, 2016)

Debbie’s story is a powerful summing up of how participating in a FACE Forward activity resulted in positive cognitive change.

‘When I first attended the art class I was extremely nervous and frightened and in a very dark depressed place. I was really unsure about attending at all. However the staff and group members were all really friendly and reassuring and made me very welcome. I have been ok in the centre now and met loads of good people who understand me and we have a cup of tea and something to eat together. I was made up with myself when I got my certificates for art and enjoy the group’s company. It helps me to talk to people who understand me and take me for who I am. In the class we all understand and support each other with our issues and are there for one another. I do believe if it was not for the FACE Forward art class I may not be alive today! My pictures are now a lot more colourful and of butterflies and ladybirds.’ (Debbie, 2016)

For some, recovery is an ongoing lifelong journey and the same is true of learning. Equally, learning about recovery can be a lifelong process. ‘Starting Over – A Road to New Beginnings’ on the journey through lifelong learning can lead to improved quality of life. If quality of life is not addressed then no amount of medication or therapy will make a real improvement in a participant’s well-being.

Written and produced by:Alec Horrocks, Senior Mental Health Practitioner NHS 5 BP/FACE

Forward Lead, Knowsley Recovery Teamand

Angie O'Neil, Head of Adult and Community Education / FACE Forward Lead, Knowsley Council

Acknowledgements and thanks go to everyone who has

contributed to the publication of this book.

Date of Production: August 2017

Issue 3