SMILING MORE OFTEN OLDER PEOPLE IN NEWHAM WITH LOWLEVEL MENTAL HEALTH NEEDS

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SMILING MORE OFTEN OLDER PEOPLE IN NEWHAM WITH
LOW-LEVEL MENTAL HEALTH NEEDS
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HEALTHCARE FOR LONDON A FRAMEWORK FOR ACTION

• 
  FIFTH PRINCIPLE
• Prevention is better
  than cure
• Promoting health and wellbeing means the NHS
  working
• more energetically with other public
  services and organisations
• All health organisations and their staff
  should be
• incentivised to take every opportunity to
  promote physical
• and mental health
• There should be more pro-active community
  care to reduce emergency admissions and lengths
  of stay
• There should be a pan-London campaign for
  activity and
• healthy eating linked to the 2012 Olympic
  and Paralympic
• Games

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INVEST TO SAVE PROJECT

• 3-year project in 3 localities of Newham
• an integrated system of support to older people
  with restricted mobility and poor mental health
  which
• is neighbourhood-based and patient-centred
• focuses on bettering health and improving outlook
  through positive activity
• builds on local strengths identified in the
  report Smiling More Often.

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SMILING MORE OFTEN INVEST TO SAVE PROJECT - 3
WELLBEING WORKERS

• Receive referrals of older people with physical
  and mental health needs
• Signpost individuals to physical and other
  therapeutic activities provided locally in
  settings friendly to older people
• Develop and support new and existing groups to
  improve physical and mental wellbeing through
  activities and peer support e.g. Reminiscence
  Group, Activity Buddies

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Context - the negative connections

• Depression increases the risk of heart disease
  fourfold, even when other risk factors like
  smoking are controlled for (Hippisley-Cox et al.,
  1998), and is a risk factor for stroke (Jonas and
  Mussolino, 2000).
• Depression has a significant impact on health
  outcomes for a wide range of chronic physical
  illnesses, including asthma, arthritis and
  diabetes (Turner and Kelly, 2000).
• Lower levels of social trust associated with
  higher rates of most major causes of death,
  including coronary heart disease, cancers,
  cerebrovascular disease, unintentional injury and
  suicide. Kawachi et al (1997)
• Physical activity preventative impact on
  Alzheimers

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Increased physical activity the positive
connections

• Associated with a reduced incidence of coronary
  heart disease, hypertension, non-insulin
  dependent diabetes mellitus, colon cancer, and
  depression and anxiety (Andrews G.R., BMJ Vol 322
  21 Mar 01)
• Advice should embrace the broader concept of
  health and activity walking, dancing, bowling,
  or gardening (McMurdo, Br J Sports Med 1998)

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A G.P. ON THE BALL.

• I have a number of elderly patients
  especially women who have been widowed who
  present to our services frequently for management
  of their health problems, e.g. high blood
  pressure, osteoarthritis, depression, diabetes
  
• Since they have been using the facilities
  provided by the Well which have included day
  trips, walking groups, Tai Chi, drama etc., I
  have noticed a marked reduction in their
  consultation rate and their need for medication
  including antidepressants, and an improvement in
  their quality of life.
• It has been wonderful to see some of our
  lonely members of the community enjoying life
  again.
• (GP, Market Street Health Group)

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Smiling More Often Project

• Supporting older people to
• become more Active in the Local
• Community

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• Encouraging
• Confidence and
• Self-esteem

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• Promoting
• Physical
• Activity

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• Working with Diverse communities

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OneOne Case Work
2 Case Studies
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Project workEmotional Wellbeing

• Telephone Social club pilots
• Bereavement focus group
• Reminiscence work

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Telephone Social Club

• Aims
• Reduce isolation and loneliness
• Increase self confidence and self esteem
• Provide social network for older people

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Asian Telephone Social Club

• Aims
• Specific cultural network for older people
• In Gujarati language
• Partnership work in local community

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Bereavement focus group

• Investigatory group to address the issues of loss
  and bereavement from a personal perspective
• Informing health professionals from an older
  persons perspective.
• Developing peer support/self help groups.

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Reminiscence

• Group workshops with older people
• Intergenerational work with young people (17-19
  years old)

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Group work producing collages of peoples lives
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Intergenerational workshop
Sharing experiences
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Project WorkPhysical Activity

• Physical Activity Buddies
• Cricket match
• Dance workshops

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Physical Activity Buddies

• Aims
• Promote physical and emotional wellbeing through
  increased participation in physical activity
• Facilitate opportunities for peer support

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Physical Activity Buddies

• What is an activity buddy?
• A volunteer (aged 50) who supports another
  person of a similar age to take part in physical
  activity

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• What they do together
• Meeting once a week over the summer -pairs take
  part in physical activity together for example
• Swimming, badminton, walking, keep fit, tai chi,
  and salsa!

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Numbers of people involved
27 People involved over 2 summer projects 12
Activity buddy volunteers (mentors) 15 People who
have had a buddy (mentees)
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Some feedback from Volunteers My buddy looks
forward to meeting me, she is happy to get out of
the house and to be going out more. Since we
started meeting each other she has decided to go
to a club on MondaysIm pleased because shes
going out of her home twice a week now. We
have a lot in common My buddy talks as much as
me, we get on really well! To help someone
makes me happy
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Some feedback from mentees

• I have really enjoyed it and made a friend. I
  know what activities I can do on my own. (G.B)
• Swimming has really made a difference, it gets
  me out of the house. (S.M)

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Cricket Match 2006 and 2007
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2007 45 participants
Stimulated interest in regular physical activity
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Dance

• Partnership with East London Dance
• Dance workshops
• Training and equipping staff and peer mentors

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Dance workshops

• Short term tasters (one off and 5 weeks)
• Longer term classes (terms of 10 weeks)
• Peer support

Day Care centre Sheltered Housing Community clubs
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Feedback
It is nice, it gives me the opportunity to do my
exercise while dancing and smiling P (African
Caribbean Day Centre)
I enjoyed the project because my movement
improved a lot MC (Dementia Care Unit)
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STRENGTHS AND WEAKNESSES

• The following annual output targets have been
  met or exceeded.
• Develop 4 - 6 groups - either building on
  existing groups or set up new - to support low
  level mental health needs through activities and
  peer support
• Deliver initial training programme (peer support
  / cascade training) 30 - 60 people participate
• Deliver physical activity tasters / projects with
  frailer older people involving 6 8
  groups/settings (60 - 80 people participating)
• Develop peer support capacity and awareness
  through schemes and resources as appropriate to
  each project area

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PARTICULAR STRENGTHS PEER-LED POSITIVE
ACTIVITIES

• Dance tasters and courses throughout the area
  East London Dance, with Leap of Faith (dance
  workers aged 55-93) in community settings and
  especially Chargeable Lane. Emphasis on
  developing peer and staff support and
  empowerment.
• 4 Reminiscence Groups now integrated into FE
  college Health and Social Care course
• Activity buddies taking off
• 2 telephone social clubs (one Asian Gujerati,
  led by volunteers)
• Developing peer-led bereavement group work

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An example of feedback from Centre Manager,
Resource Centre for Older People, Chargeable Lane

• Staff who have been on the dance training can
  apply what they have learned to other groups,
  hopefully maintain their skills with more
  training, and pass them on to new staff. The
  professional approach of East London Dance has
  enabled users to reach a higher potential than
  our staff would have dared to approach.
  Seeing it was amazing, how adventurous people
  were, the level they were stretching to.

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Achievements continued

• Activity maps an alternative to the
  prescription pad, raising performance in
  community provision
• Developing critical mass of preventative activity
  in the community multiplier effect, capacity
  building
• Social inclusion effect

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Weaknesses

• Outcome evaluation process set up (for reduced GP
  consultations, prescribing, admissions)
• BUT - Poor referral rate from GPs, in spite of
  much groundwork
• Referrals often too dependent to take up activity
  - high level of loss and bereavement, need for
  listening and support few easy wins
• Outcome evidence therefore very weak - findings
  unlikely to be significant
• Therefore project built in community primary
  care not in the loop

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• Simple wellbeing questionnaire designed with DH
  approval but staff perception that it interfered
  with motivation of older people with very fragile
  motivation if any - small scale use, but will be
  some findings
• Hierarchy of proof is evidence of creation of
  volume of preventive activity sufficient in
  research context?

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NHS cost gains (Curry, Kings Fund, Preventive
Social Care Is it cost-effective? (for Wanless
Review, 2006)

• Cost effectiveness of prevention lack of
  quantified evidence
• Regrettable if (White Paper emphasis on
  prevention) did not extend to low-level
  interventions
• Recognition should be given to the wealth of
  qualitative evidence about value placed on lower
  level services

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Where to from here?

• Funding runs out March 08
• Models that engage older people in peer support
  widely perceived to be a success Activity
  buddies / bereavement group work / reminiscence /
  dance
• Common strand bereavement and other loss
• Adding to the small pool of active older people
  giving peer support
• An effective, creative team with a track record
  in borough, just taking off
• Model for preventative wing of polyclinics - ways
  of engaging older people in community / people
  with longterm conditions in community based
  health support

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The context

• Local Area Agreement
• Commissioning Strategy Plan
• Practice based commissioning
• Olympics health gain aim
• Using small area mapping of indicators to
  identify where and how to apply these strengths
  in commissioning