Mental Health Users and the Arts

1
Mental Health Users and the Arts

• Sue Hacking
• Department of Nursing
• University of Central Lancashire
• Part of the Anglia Ruskin/UCLAN research team
• Arts, mental health and social inclusion
• developing the evidence base
• Jenny Secker, Helen Spandler, Lyn Kent,
• Jo Shenton

2
What do we know already?

• Participation in the arts holds promise
• For promoting well being
• For promoting social inclusion
• Less is known about the benefits for people with
  mental health needs

3
Research objectives

• To identify appropriate indicators of mental
  health and social inclusion outcomes
• To develop an evaluation framework based on those
  indicators
• To identify the characteristics of effective arts
  and mental health projects through implementation
  of the evaluation framework

4
Design of study

• Mapping survey
• Identification of indicators measures
• Retrospective analysis of project data
• Workshops with projects and participants using
  realistic evaluation to test out theories of
  change

5
Measuring Social Inclusion

• Context
• Development
• Measure

6
Context

• Arts, mental health social inclusion
• developing the evidence base
• Phase 1 survey of arts mental health
• projects
• Phase 2 outcomes study qualitative
• work
• Ongoing literature review

7
Development of the measure

• Literature review, current practice national
  surveys
• Categorising concepts identifying
  prioritising useful questions
• Consultation meetings
• Piloting
• What are the most appropriate outcome measures?
• Perceptions/beliefs of patients/staff

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Hard Outcomes are the clearly definable and
quantifiable results that show the progress made
towards a goal. Hard outcomes are usually
straightforward both to identify and to measure.
Soft Outcomes those outcomes that represent
intermediary stages on the way to achieving a
hard outcome (e.g. improved problem-solving
abilities, improved self-confidence) or perceived
benefits. They can be more difficult to define or
measure.
9
Literature review

• Social exclusion and social inclusion not direct
  opposites
• Social capital theory bonding and bridging
  capital
• Some useful lines of questioning from previous
  studies
• Distance travelled a useful concept

10
Distance Travelled refers to the progress
beneficiaries make in achieving soft outcomes
that lead towards sustained employment or
associated hard outcomes, as a result of
participating in a project and against an initial
baseline set on joining it. By definition,
measuring distance travelled will require
assessing clients on two or more separate
occasions to understand what has been achieved.
Measuring Soft Outcomes and Distance
Travelled Department for Work and Pensions 2003
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Current evaluation practice

• Few projects evaluating social inclusion outcomes
• Some useful lines of questioning
• Attributing causality

12
National Surveys

• Some useful questions, but

13
Categorising and prioritising

• Lines of questioning grouped in relation to key
  concepts
• Priority given to service user perspectives

14
Consultation meetings

• Emphasis on design and layout
• Relevance of housing

Piloting

• Service user research group two arts projects
• Rating scale unpopular
• some national survey questions seen as overly
  complex

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The measure

• Scales comprising 22 items asked to respond in
  relation to the last 3 months (Not at all, Not
  particularly, Yes a bit, Yes definitely)
  related to national survey question
• Bonding capital (3)
• I have felt isolated from my family
• I have friends I see or talk to every week
• My social life has been mainly related to mental
  health services or people who use mental health
  services
• Bridging capital (3)
• I have been involved in a group, club or
  organisation that is not just for people who use
  mental health services
• I have learnt something about other peoples
  cultures
• I have been to new places
• Acceptance (5)
• I have felt accepted by my friends
• I have felt accepted by my family
• I have felt accepted by my neighbours
• I have felt that some people look down on me
  because of my mental health needs
• I have felt that what I do is valued by others

16
The measure

• Neighbourhood cohesion (2)
• I have felt it was unsafe to walk alone in my
  neighbourhood in daylight
• I have had problems with my neighbours
• Stability of housing tenure (2)
• I have felt insecure about where I live (for
  example Ive been afraid I might be evicted)
• I have been behind with my rent / mortgage
• Engagement in leisure cultural activities (3)
• I have done a sport, game or physical activity
  (not just walking to get somewhere)
• I have been out socially with friends (for
  example to the cinema, restaurants, pubs, clubs)
• I have done some cultural activities (for example
  gone to a library, museum, gallery, theatre,
  concert)
• Citizenship (4)
• I have helped out at a charity or local group
  (other than a mental health group)
• I have felt clear about my rights
• I have felt free to express my beliefs (for
  example political or religious beliefs)
• I have felt that I am playing a useful part in
  society

17
The measure

• Employment and education opportunities (3 items),
  routed responses
• Do you have a paid job now for which you are
  paid the going rate? If yes, how many hours a
  week do you usually do paid work?
• Do you work as a volunteer or in an unpaid work
  placement? If yes, how many hours a week do you
  usually work?
• Are you currently working towards a
  qualification? If no, are you planning to work
  towards a qualification?
• Housing (1 item, 8 options)
• Where are you living at the moment?
• A house, flat, bedsit, room or mobile home with
  other people
• A house, flat, bedsit, room or mobile home by
  myself
• Bed breakfast accommodation
• A hostel or group home
• A hospital ward
• A residential or nursing home
• I dont have a fixed address
• Other

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The measure

• Attributing causality at follow up
• At the end of each section
• Thinking about all the questions you have just
  answered, do you think that being involved with
  your arts project has helped you in these ways
  (items linked to scales/questions)
• A lot, A little, Not at all, Unsure

19
Progress

• Qualitative component under analysis
• Baseline analysis almost complete
• Awaiting return of 6 months follow up
  questionnaires
• Testing reliability and validity of the scales
  and measures

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Reliability

• Reflects the amount of error, both random
  (inaccuracy, measurement mistakes) and
  systematic, inherent to any measurement
• Determines the degree of confidence we can place
  on inferences made based on the scores from the
  scale

Validity
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Good measures should be .

• Comprehensive (content validity)
• - includes appropriate components of
  health/social
• Credible (face validity)
• - appears sensible and interpretable
• Accurate (criterion validity)
• - consistently reflects true clinical status of
  patients
• Sensitive to change (discriminant validity)
• - detects important differences
• Make sense (construct validity)
• - matches hypothesized expectations when
  compared with other indirect measures