23. Building Community Partnerships to support people to Live Well: Creative Minds
Phil Waters – Strategic Lead for Creative Minds and Julie Repper – Director (Strategy, Innovation and Development), ImROCIntroduction
Dr Steven Michael OBE, ImROC Chair of Trustees
Throughout my career working in mental health services I have seen how helpful creative activity can be in supporting people (including myself) to stay well. These activities provide a sense of peace, creativity, purpose, achievement and connection for people who have lost confidence and a purpose and meaning in life. As CEO of South West Yorkshire Partnership NHS Foundation Trust our mission, informed and co-produced by local people, was to help people realise their potential and live well in their own communities.
Within these communities there are so many opportunities for people to join together in local groups and facilities to make art, poetry, film, to join knitting groups, craft circles, pottery workshops, choirs and music groups. For those who seek connection through more active pursuits there are walking, climbing, sailing, sports, cultural, political and faith groups.
I was fully aware of the limitations of health services in supporting people to rebuild their lives and wanted to find a way of linking all those using mental health services with communities of their choice. The seeds of this idea germinated in my own mind to become Creative Minds.
In practice the network (or movement) has been led and supported by hundreds of local people, some of them who use services, some work in services, but with the vast majority simply doing the things they enjoy doing in their communities. This paper describes the development of Creative Minds, how it works, who is involved, what difference it makes and how others might take these community-focused innovations forward in their own localities. Creative Minds is developing a package of support to organisations who wish to follow a similar route of development with contacts on the final page of this paper.
Fundamentally all of our mental health is sustained by our connections with others. The Creative Minds approach has the power to enable, engage and empower these connections.
The Power of Community
Communities are an essential part of all of our lives. They include the neighbourhoods we live in, the groups that we connect with, the activities that we engage in, the people who we relate to. They include places, people, organisations, services, groups beliefs and interests. They are mobile, agile and, as shown so remarkably during the CoVID-19 pandemic, they can come together to overcome challenges and support each other. They have knowledge, skills, time, space, ideas and assets and they are essential for us all to live well. The Community Mental Health Framework for Adults and Older Adults (2019) recognises that communities are central to good mental health.
It aims ‘to enable healthcare providers and commissioners, STPs, ICSs, Primary Care Networks and people who use and have experience of services to work together to deliver a model that reinvigorates community provision and fully utilises the resources of the wider community’ with individuals ‘contributing to and participating in the communities that sustain them, to whatever extent is comfortable to them’. It recommends ‘strengthening relationships with local community groups and the VCSE to support the adoption of more rights-based care based on greater choice and engaging early with communities to address inequalities’; and ‘creating effective links with community assets to support and enable people to become more embedded within their community and to use these assets to support their mental health’.
Although the naturally occurring benefits of community engagement and development are rarely measured, there is increasing evidence of the potential that exists in communities. Pollard et al (2021, p.10) summarise the benefits of community power as:
Improving individual health and wellbeing though people being active participants in all efforts to improve health and wellbeing.
Strengthening community wellbeing and resilience as people are engaged in decision making and enabled (with resources and infrastructure support) to take action locally.
Enhancing democratic participation and trust by coproducing decision making with local citizens and organisations at local level.
Building community cohesion from the ground up by anchoring engagement and participatory approaches at a local level taking local history, strengths and challenges into account.
Embedding and early intervention across all public services – education, transport, criminal justice as well as health and social care.
Generating financial savings by reducing reliance on statutory services and enhancing confidence and capability at individual and community levels.
How can health and social care services work with communities for the benefit of local people?
The questions that remain for those health and social care providers that have increasingly – often inadvertently – tried to replace the role of communities through the provision of segregated spaces such as day centres or prescribe a role for communities as a step-down facility for those leaving services, is just how to support the central role of communities. How to access the power of communities and how to work collaboratively with the huge range of community assets and resources rather than exploiting, overpowering or ignoring the facilities, roles, relationships and activities that give life meaning and are central to living well. Or, as Russell summarises this challenge, how do we debunk the belief …’that institutions are the primary producers of what we need to live a good life of prosperity and well-being by repositioning and re-centring regular people and their communities and recognising them as the primary producers and contributors of those things that lead to increased well-being and health’ (Russell, 2023).
There already exist tried and tested approaches to realise or release the power of communities. ImROC has previously described the power of a local coproduction forum with local citizens, organisations and services as a means of sharing intelligence about what exists where, identifying gaps in provision and resources and fully participating in decisions about local community development. We have also demonstrated the benefits of employing peer support workers to enable people who are excluded, isolated and inactive to engage in activities, relationships and facilities of their choice; the power of social prescribing services to link people with local resources; and the impact of building competence and confidence of local communities’ resources to accommodate people with particular needs. This paper describes a different approach to community engagement and development. One which facilitates the power and resources in local communities in order to improve opportunities for people with mental health challenges to both participate in and contribute to meaningful activities, relationships and facilities of their choice in their communities.
What is Creative Minds?
Creative Minds was set up in 2011 to support the development and delivery of creative arts, sports, recreation and leisure-based projects to improve the lives of people who use South West Yorkshire Partnership NHS Foundation Trust (SWYPFT) services. Creative Minds has developed into a charity hosted by SWYPFT with over 120 community partners developing over a 1000 community-based partnership projects across the footprint covering Barnsley, Calderdale, Kirklees and Wakefield. These projects offer opportunities for people who use/ have previously used SWYPFT physical and mental health services (including Yorkshire and Humber Forensic Secure Services) and build the confidence, competence and capacity of local communities.
We know that the context in which people live their lives is the most important determinant of life expectancy, and our ambition is to make sure that every person experiencing health issues using the local NHS organisation has the opportunity to engage with meaningful activities in their community and achieve their potential. Many people readily engage with NHS services – and Creative Minds activities are complementary to the service offer. However, for people who avoid using services, reject their diagnosis, and/or disagree with a medical approach, Creative Minds offers complementary and alternative approaches in the community. By having one foot in the NHS and one foot outside, Creative Minds can get alongside individuals who use services and support them to connect with meaningful activities in their communities and neighbourhoods that help individuals to regain, hope, meaning and fulfil their potential.
Creative Minds is the broker or the bridge between the SWYPFT and the communities it serves. It seeks to remove the barriers that inhibit partnership working. Traditionally, community organisations and groups have found it difficult to work directly with the Trust due to slow decision-making processes, difficult payment systems, risk averse attitudes and a culture that may not recognise the value of creative approaches. Creative Minds’ approach is very much based on community development principles and asset-based approaches and operates more like a social movement, that empowers local communities to be part of decision making and development.
A major aim of Creative Minds is to build a strong infrastructure of community and voluntary organisations, providing communitybased activities and relationships for all those who wish to engage with them, starting with those who access NHS services in the SWYPT footprint. Creative Minds works in partnership with individuals and groups in the community to coproduce opportunities for people to engage in activities that are meaningful and fulfilling to them. It supports the development of projects through mentorship and guidance to enable them to access external and Trust funds and to enhance both inclusivity and confidence to enable people with long term condition and challenges to fully participate. The passion and commitment to creative approaches that are held by the network of external champions helped bring Creative Minds to life. Champions also work within SWYPFT to support the development of projects, allocated according to their geographical locality and their areas of interest.
Inception of Creative Minds
Creative Minds grew out of a series of workshops that brought SWYPFT service users/carers staff and community partners together to gain a broader understanding of the needs of the population served by SWYPFT. Feedback stressed that engagement in creative activity can be invaluable in recovering a meaningful life, and that this was best provided in a safe, supportive environment. Participants felt that more creative projects would be initiated – and those already in existence would become more accessible – with support to set up and get started. And individuals currently using Trust services felt they could benefit from some initial practical and emotional support to engage in activities. However, there was agreement that projects would find ways of running independently in the longer term, just as participants would gain confidence over time. The workshop feedback generated an approach in which as participants engaged in activities they could begin to imagine a different life for themselves and move from the narrow confines and definitions of life as a receiver of healthcare towards new horizons as a contributing citizen. Creative engagement was also seen as an opportunity for people to partner as equals, to shift the power imbalance between care providers and the cared for, and for people to progress towards personal autonomy through developing a creative passion.
From these workshops in 2011, the Trust committed £200,000 funding to match fund community-based projects to improve inclusion and support for people with ongoing mental and physical health conditions.
Aims, objectives and values of Creative Minds
The agreed aim of Creative Minds is to develop access and take up of creative activities to improve the wellbeing of participants by increasing their self-esteem so they feel confident to try new things, develop social skills as they meet new people and feel a new sense of purpose and confidence as they engage in activity that they find meaningful and fulfilling.
Creative Minds’ objectives are to:
Increase participation in creative activities for people who use Trust services.
Coproduce quality creative practice and approaches within community based organisation.
Increase inter-agency partnerships and bring in more funding for creativity and wellbeing.
Develop a research/evidence base regarding creative approaches in relation to health, wellbeing and living well.
The values of Creative Minds are the guiding principles of all they do. Coproduction lies at the heart of their approach, from the way they developed to the way collective decision making continues to drive project development. Co-producing creative projects adds substantial value to the Trust’s overall service offer by exploring areas beyond its current provision and co-creating new and innovative solutions to the issues faced by individuals and communities. The approach builds and uses social capital to create and restore a community spirit that enables people to reach their potential and live well in their communities, which is the Trust’s coproduced Mission. Working and delivering services in partnership has large mutual benefit for all as people learn from each other: community organisations and groups have greater awareness of mental and physical health conditions and the Trust learns more about creative approaches and how community organisations operate. Creative Minds offers more opportunities for people who use services to join activities alongside people who don’t use services as equals. This reduces discrimination self-stigmatisation and builds confidence and capabilities for all.
Staffing of Creative Minds
The Creative Minds strategy was originally developed with the Trust’s Equality and Inclusion team who facilitated coproduction workshops to agree a strategy to drive the early initiatives. As projects grew in popularity it was clear that the approach was becoming an entity in its own right and in 2015 Creative Minds became a registered charity. The Trust supported a business case to create a separate staffing structure to manage and develop Creative Minds projects and to explore the potential to expand the approach and draw down new sources of funding. At this stage an independent staffing structure was agreed including: a Strategic Lead, four Development Coordinators and Project worker to support the development of Peer Led Projects. A growing number of volunteer Champions became involved through the strategy workshops and stayed with the development and decision-making process. These Champions included people using services and staff working in teams who had a passion for creative activities and helped to build strong pathways to connect with people using services and codeliver some of the projects. These now amount to 4-500 people who have a firm connection to support the work and can be described as a social movement. Additional funding allowed for two Creative Practitioners posts and four project worker posts.
How Creative Minds supports projects
In line with the organisation’s values and Equality and Inclusion roots, processes around development and decision making have always been inclusive. Collective decision-making groups were established in each of the Trust’s localities in Barnsley, Calderdale, Kirklees and Wakefield. The collectives continue to be made up of people with lived experience, carers, Trust Staff and community representatives and they manage the locality share of the funding. Young Foundations Community Development tool (Osbourne et al, 2021) is used to support project development which builds on strengths and targets support to any area’s weakness. The collectives continually identify and respond to gaps and needs in their local community and ensure that projects are targeted on those in the greatest need. The collectives are always open to new members to ensure strong pathways are created and any barriers to a project working are quickly identified and addressed.
Case Vignette 1: Partnership with Barnsley Football Clubs’ charity Reds in the Community
Barnsley FC wanted to make the club more dementia friendly, believing that if people with dementia could keep coming to the club it would be good for their wellbeing. They also felt the club’s historical archive would make a great basis for a memory group. The response from services was, “what do Barnsley football club know about dementia” our view was ‘ quite a bit!’. Through working with the club’s charity, we brokered a meeting and we persuaded services to get involved and Creative Minds matched the funding the club had raised and the work started. The initial project was a big success working with the Trust’s memory team and since then other approaches have developed including walking football and creative writing. The creative writing and poetry from the groups is now on permanent display at the club’s main entrance and forms part of their dementia awareness raising campaign and part of making the club more friendly to people with dementia. More recently we have developed Safety Nets a health and wellbeing programme that takes young people off the CAMHS waiting list. The coaches from the club provide physical activities combined with wellbeing session from CAMHS staff, the programme on average sees a 30-40% increase in the Shorter Warwick and Edinburgh Mental Wellbeing Scale. Barnsley CAMHS said;
“We get very positive outcomes and feedback resulting from delivery of these projects, many participants reporting life changing experiences and many young people want to stay on as volunteers and are less reliant on service”
How Creative Minds supports individuals
The projects developed and delivered through partners, complement and enhance the services that people receive from the NHS and support their recovery. They also offer an alternative for people who do not engage readily with statutory services. These are often people who suffer the most in terms of health inequalities. The loneliness and social isolation that people were feeling has been compounded by Covid 19 which exacerbated the challenges and issues that people have in managing their mental and physical health and wellbeing.
Case Vignette 2: “I would have ended up on the streets” – Babur’s story
In his late teens, Babur experienced anxiety and depression which ultimately led to him to being given medication and referred into the Calderdale insight team at the Trust. Working with the team, Creative Minds developed and funded a rock-climbing scheme that people who use services could access. Babur began his rock-climbing journey here, as part of his treatment, and hasn’t looked back since! Babur is now in full-time work and completed his rock-climbing instructor training. Babur wanted to give back to the service and Creative Minds so he now volunteers for the insight team and supports Creative Minds projects, including running weekly climbing groups and other outdoor pursuits. Babur gets to share his lived experience with people that use Trust services and share his recovery story with people whose shoes he was once in. Babur’s general health and fitness is also much improved as his diet and exercise are now designed to build upper body strength so he can climb better. Babur’s story is one of hundreds of examples of how Creative Minds has worked with the Trust to improve patient experience and outcomes. You can also hear from Babur on his personal experience through this film here.
Freedom to be agile and innovative
Although Creative Minds is hosted by the NHS, it is a charity in its own right. This brings a number of benefits. First bespoke relationships with community organisations can be developed, operating in a flexible and agile manner unencumbered by some of the bureaucracy that can stymie creativity in large statutory organisations. Second, being hosted by the NHS gives more influence within the local health-care system than coming from an external position would offer.
Case Vignette 3: Extending Creativity into decision-making processes
A number of Creative Minds’ partners tried to work with the Trust previously and the decision-making process to achieve matched funding for a project took 3-4 months. However, the funding was only available for a 1-month period which precluded the possibility of success. Creative Minds partnership agreements allow partners to become preferred suppliers and set up a process that enabled community organisations to plan project development. Projects are also more successful with support from staff champions, who hold a big influence on changing organisational culture more positively towards creative activities. This arrangement also included using Trust budgets in more creative ways when recruitment had been difficult, leading to more creative activities being delivered on inpatient wards.
Case Vignette 4: Innovation in Action
Creative Minds have been working with Public Health in Barnsley, to develop a community accreditation scheme to enable local sports and recreation clubs to become more mental health friendly and provide a more supportive environment for people who have mental health issues. Part of the scheme is to provide the clubs with mental health awareness and Mental Health First Aid training. The initiative has been promoted with a ‘Moving Mental Health Forward’ logo that has been adopted by Barnsley Council. Creative Minds are starting to build pathways for people from secondary Mental Health Services to enable a more guided route for people might struggle to engage with the clubs. Benefits of being active.
Impact of Creative Minds
Creative Minds supports the development of projects that welcome people with ongoing mental and physical health challenges. In so doing the organisation believes Creative Minds reduces loneliness, social isolation and inactivity and the associated loss of confidence, poor self-esteem and feelings of negativity. Thus, these projects serve to build emotional resilience, providing healthy boundaries, supportive peers, self-awareness, and openness to change. Increased resilience keeps people well and able to cope with life challenges, reducing the risk of them needing NHS services. Creative Minds meet people every day who recount their own positive stories so are convinced of the benefits to their approach. However there is relatively little ‘gold standard’ research evidence to demonstrate the benefits of the approach.
A new means of evaluating creative activities has been embraced. A peer-led network of Community Reporters was trained to collect stories from participants of creative activities, to evaluate creative activities and provide new insights into why participants feel these activities are important to mental health recovery and wellbeing. This new approach to evaluation was to support people to tell and share stories of their experience of using creative approaches to recovery and/ or wellbeing through Community Reporting. Community Reporting is a storytelling movement that was started in 2007 by People’s Voice Media and it uses digital tools such as portable and pocket technologies (tablets, smart phones) to support people to tell their own stories in their own ways. Central to the approach is the belief that people telling authentic stories about their own lived experience offers a valuable understanding of their lives. Participants also complete a shortened version of the Warwick & Edinburgh Mental Wellbeing Scale and, on average, people engaging with Creative Minds demonstrate a 40% Improvement in their WemWebs score. (Give exact results).
Community Reporting has published summaries of peer led and collaborative evaluations of different Creative Minds projects https://communityreporter.net/ feature/sport-and-wellbeing-good-moodleague and https://communityreporter. net/story/soft-and-fluffy-friday-7-february2020-137pm.
These reports show how project groups establish healthy boundaries to focus on the activity, not an individual’s problems, participants share ground rules and develop social norms. Project groups increase participants confidence and their ability to make and maintain healthy relationships with their peers. It also gives them lived experience of relationships based on shared interest. Groups are a safe environment where participants can test out relationship building skills and establish social networks that support them. This creates a ‘healthy interdependence’ and begins to create and extend social networks. Participation in the creative groups raise aspirations and hope, people with higher aspirations achieve more and work to extend their abilities.
Creative Minds Evaluation Results 2017/18
Attendees of all Creative Minds projects are invited to rate their thoughts and feelings before a project commences and 3 months into the project or when it ends: (134 people completed the evaluation in 2017/18). Whatever it is, the way you tell your story online can make all the difference.
My Personal Life
"I was low in confidence and self-esteem before starting the courses. I lacked opportunity and confidence talking to people, so doing the courses has helped tremendously. I am now attempting to make a living out of art rather than just seeing it as therapy. Working alongside other people has increased my confidence and self-esteem."
"I have gained problem-solving skills and it has felt good to contribute towards something that has a positive effect on the world."
“It was life-changing and I am feeling so peaceful about the future."
My Health
"My general sense of wellbeing has improved and having a sense of connection with community and a way to be useful to others has improved my overall mental health."
"Keeps brain active, relaxing, challenges me to do more things, pushes me."
"Managing my chronic health issues better."
"My mental health has greatly improved and although in the past couple of months I’ve had heart problems, I am able to deal with it positively.
My Social Life
"I met new people. The people were nice, there were some lovely people and they were very friendly. I might see some of them again if we can go again."
"I enjoy my social activities because I made friends and it has helped me to build my confidence up."
"I’ve become part of a community of people who are all involved in doing good for the community and this provides me with a support network which gives me help when I need it. Being part of a team has helped improve my team-working skills and given me more awareness of the needs of others."
Peer led projects
The area of work that involves beneficiaries the most is in the peer led projects that are supported by Creative Minds. Peer led projects are a priority area for development; where participants from an existing programme who develop a passion for a particular activity can go on to develop their own groups. Together a safe process has been developed whereby peerled groups are supported to set up a simple constitution and community bank account to get started. Where possible these groups are hosted by one of the Creative Minds’ partners to give an extra level of support to get peer groups established.
What difference has Creative Minds made on culture and practice inside and outside local mental health services?
A major aim of Creative Minds was to build a strong infrastructure of community and voluntary organisations to work with to provide excellent creative projects for all who access NHS services. Therefore, to the conception and development of Creative Minds. It not only shows commitment, as an organisation, to having a creative approach to service delivery but also showcases passion for working in partnership with communities. Creative Minds has provided a way to not only build on existing good practice in NHS services, but also to work more closely with a wide range of community organisations enhancing service provision by delivering innovative, transformative and meaningful health and wellbeing projects. The passion and commitment of external champions to creative approaches has helped to bring Creative Minds to life. This infrastructure helps to embed this different way of working across all aspects of the organisation’s work.
Projects are offered that are suitable and targeted toward people who use SWYPFT services including those with a mental and or physical health diagnosis and people with a learning disability. The projects are generally open to all age groups, but there are some projects that are age and condition specific to ensure they are more suited to groups with particular needs. The group size is usually between 15-20 people, but some groups like the Art’s Café and the Good Mood Football league have up to a 100 people attending.
Within its health system, Creative Minds are creating a paradigm shift, from one that is about ‘doing to’, to one that is about creating the right conditions for individuals and collective groups and communities to do for themselves and each other. This requires a fundamental shift in power to people with lived experience and communities recognising them as equals in a relationship that creates value through meaning and hope. The principles and philosophy of Creative Minds seemed to strike a chord with many people in the NHS. It appears to have initiated a genuine social movement of which people want to be part, and for which people feel a sense of ownership.
This seems to resonate with people involved in Creative Minds and is evident from many more staff members becoming champions, but also people with lived experience wanting to get involved. This fits with theories being developed at the NHS Institute for Innovation and Improvement by Helen Bevan REF “The social movements perspective fundamentally challenges the ways that we have learnt to organise and lead change in the NHS. It advocates that healthcare improvement strategies need to extend beyond the topdown programme by programme approach to embrace a concept of citizen led change”
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