18 August 2022
Centre for Mental Health is evaluating OHID’s Better Mental Health Fund, working with 40 of the most deprived areas across England. Here, David Woodhead speaks to Angela Burns (a public health programme manager in Tower Hamlets), and Graeme Greig (a senior public health practitioner at South Tyneside council) to hear how they’ve been using the fund to improve the mental health of their local communities. They talk about working with the voluntary sector, delivering mental health support across cultures, and what real impact looks like.
Transcript
David Woodhead: Good afternoon, everybody and thank you for tuning in to our podcast. My name is David Woodhead. I’m the Associate Director for Research at Centre for Mental Health. And we are delighted to be working with the Office for Health Improvement and Disparities, evaluating their national programme, the Better Mental Health Fund, which is working with 40, four-zero of the most deprived areas, the areas where there’s greatest inequality across England. And I’m delighted this afternoon to be joined by two of the key movers and shakers in that work, Angela Burns from Tower Hamlets and Graeme Greig from South Tyneside. So I’m gonna ask them to introduce themselves. Angela?
Angela Burns: Thanks, David. Yeah, hi, I’m Angela Burns. I work in Tower Hamlets as a public health programme manager for the council focused on mental health and generally focus on adult mental health.
David Woodhead: Thank you, and Graeme?
Graeme Greig: Hi, I’m Graeme Greig. I’m a Senior Public Health Practitioner. I work for South Tyneside Council, and I’ve got the lead for mental health, population mental health. And part of that includes suicide prevention as well.
David Woodhead: That’s great. Thank you. So what I’m going to ask you now to do is just to tell us a little bit, assume that we don’t know very much about the places where you work. And just tell us a little bit about what it’s like living in South Tyneside for the people in the communities that we’re working with on this programme?
Graeme Greig: Happy to do that on South Tyneside. It’s a fairly small geographical area in the northeast, one of 12 councils; it has a population of about 144,000 people. I think probably it’s typical of lots of places in the northeast, it has some small pockets of affluence, and it’s got lots of areas of Multiple Deprivation. big gaps in life expectancy between our best wards and our worst wards. We’ve got lots of, if you want, natural assets, a lovely coastline. South Tyneside coastline, as you know, I think you’ve been to this part of the world is beautiful, tremendous, lots of parks and lots of green spaces as well, so many challenges for us, but you know, many positive things as well, from a kind of greens spaces mental health perspective.
David Woodhead: And in terms of ethnicity, how would you describe South Tyneside?
Graeme Greig: It’s probably about 95% British white population. Okay. Our last census I think that was the kind of figures that we had, about 95%.
David Woodhead: That’s interesting, because I suspect it might be a slightly different story in Tower Hamlets.
Graeme Greig: Yeah, I think that’s probably a reflection of, of not all of the Northeast, but probably the majority of the Northeast on on the whole.
David Woodhead: Thank you. And Angela, tell us about Tower Hamlets. I have to say I studied in Tower Hamlets many years ago. So I do know it’s it has changed quite a bit in those 30 years since I was a I was a young student on the Mile End Road.
Angela Burns: Yeah, it’s definitely it seems like it’s always changing environment. Yeah, so Tower Hamlets is in inner East London. It’s a population of I think just over 320,000 people. And like Graeme was saying there is quite a bit of diversity in terms of income levels, there’s some of the highest rates of child poverty in the country, while at the same time being home to a major financial centre in Canary Wharf where there’s huge corporations located. So quite a bit of difference and also kind of everything in between that.
And then, in terms of cultural diversity, also immensely different. Many languages that are spoken, I think close to 70% of our population are not white British. And more than a third of our population are of Bangladeshi origin. And kind of on similar lines, we have the highest population of Muslim people in the UK, which is about I think just under 40% of our population. So, but even aside those kind of larger groups, there’s quite a bit of difference, I think among ethnicities and cultures in the borough. So it’s a very interesting place.
David Woodhead: Very dynamic. So in the context of those two very different pictures, it’s clear that there’s inequality in both social inequality related to different factors. That’s for sure. And a large mental health needs. I mean, I think that’s that’s a given isn’t it in any of these places that the better mental health fund has been working with. So tell me a little bit about, you know what you’ve used the Fund for, maybe a couple of examples of projects that you think are particularly effective, or from which you’ve learned the most. Angela, do you want to start with that?
Angela Burns: We’ve used the funding to deliver quite a bit considering the amount of time we’ve had. So broadly, we’ve delivered quite a bit of training on different topics, so mental health and workplaces for small businesses, training about trauma and trauma informed approaches, running different pilot projects in relation to trauma informed approaches, but I think one of the more extremes that I think I’ve learned the most from, that I want to kind of get into more detail about was around, we worked with four community voluntary sector organisations, who work with kind of more specific demographic groups.
And the whole point of the projects was to, I guess, increase uptake of things like the Five Ways to Wellbeing, and the kind of free self help resources that are available, that might not be so easy to access for people that kind of need a bit more adaptation, or might face barriers to generic resources. So the four organisations we partnered with, three of those work with different minority ethnic groups. So two who kind of tend to work with the smaller communities, and one focused on the Bangladeshi community. And then the other was our local care centre. So basically, those projects involved an initial kind of like insight phase, where they were hosting workshops with some of the people they work with, to get a handle on what they think of those interventions that I mentioned. And also what they think would be good ways to communicate and engage on the topics. Knowing that there are definitely adaptations needed to kind of get messages across and get people more engaged.
And so really, there was, aside from that content being what we wanted people to do more of, there’s quite a bit of flexibility and like, or just letting those organisations and the people that they work with kind of take the lead on what the structure and the actual operations should look like. And it’s been really interesting. I think, as you can imagine, by the different organisations I’ve mentioned, they’re quite different in terms of the types of communication that might be useful. So like, finding different words that resonate in different languages, for things like loneliness, or, even of course, like mental health, too.
David Woodhead: It’s not just translating words, is it? It’s the kind of deep cultural meanings that are attached to these words that are really, really important to capture?
Angela Burns: Absolutely, I think the point around not just Google translating, or even just paying professional translators, sometimes you kind of can miss the cultural meaning of certain things. And actually, some languages do work better in the oral tradition, or the oral methods of communication. So some of the groups have, like really emphasised the use of like WhatsApp voice notes, as a way of sharing messaging to groups that they already had. So I think it’s been really great to see how they’ve used their expertise with the people that they already work with to promote things like Five Ways to Wellbeing.
David Woodhead: And that’s one of the clear, isn’t it that we know this, but we need to be told it over and over again, that’s one of the clear benefits of working in close partnership with voluntary sector and community sector organisations, that they can do that work very quickly and swiftly. And because because they know their communities in a way that perhaps statutory sector organisations can’t, which is interesting.
Angela Burns: Yeah, I think what I’ve learned from that is that it actually saves quite a bit of time and energy. Like not trying to do everything yourself as the council, but like, building off of what’s already there in terms of the relationships that those organisations have, and the trust that they have. Because that, like trust, definitely, it takes quite a bit of time for people to to see you as a viable source of information and who they’d want to listen to.
David Woodhead: It takes a long time to build but can be dismantled quite quickly, can’t it? Trust. So those relationships are really key. And I think some of the emerging things from the evaluation that certainly is something you know, your experience in Tower Hamlets is what’s been, you know, it’s been reported in several places that aside of the transactional business, it’s things like trust that actually really matter when you’re trying to work at speed with these communities that you’re hoping to have an impact with. Thanks, Angela. Graeme, give us some examples of what’s happening in south Tyneside?
Graeme Greig: I was just fascinated by what Angela just said about, you know, speaking and talking to the voluntary sector organisations, because that’s one of the things that we did very early in the fund. I mean, David, we’ve talked about the timescales before were quite tight. So we looked at the criteria. We thought a little bit about the demographics of the borough. We’ve got a very ageing population, lots of problems with long term conditions, social isolation, and debt as well is a big issue in South Tyneside. So we took a similar approach, we went and spoke to three or four the voluntary sector organisations and had a conversation about the kind of fund criteria. And then about the work they were doing really, with their communities, which they know really well and probably in some respects better than we do at the council.
And one of the projects that emerged from that was a project on tackling isolation in older people with Age Concern in South Tyneside. And this is really about identifying older people over the age of 65, who identify themselves as isolated, and then developing a volunteer programme, telephone-based to start with, Age Concern’s got quite large database of people in the area, and through telephone contacts, and telephone befriending in the midst of Covid. Because of this is when a lot of this work was developed, kind of making those calls and then checking in on people, making sure they’re okay. And then the second part of that was really to try and then, when the Covid restrictions were lifted, was to try and get people linked in to activities in the community, whether they were like, social type groups where, you know, people can come together and do arts or whether it’s walking, or whether it’s some physical activity. So it was a bit of a slow burn to start with. But I think, you know, the numbers they’ve had coming through the programme have been really good. And it’s highlighted a whole range of other stuff, I think, for us as a council probably that were self evident, but maybe things you don’t think about. So the main project leads, we had a visit from OHID about three weeks back. And the project lead was was sent to us, you know, you got an older population, long term conditions, a lot of people who haven’t gone out the house for a long period of time, because of Covid. A lot of these people have lost a sense of their independence, but they’ve also lost a lot of their mobility as well. So it’s a bit of a double whammy, this kind of physical effect that people have, because you know, what they say with exercise is ‘use it or lose it’. And I think that’s that’s true. It’s true at all age groups. But I think especially as you get older, and I think the other issue of not having those social connections and not having that kind of friendship, and that stimulation that people need. So that’s been one of the projects that we’ve that we’ve done. And that’s evolving all the time now. So slow burn to start with but again, really valuable. So that was one.
Another project that we had, because we’ve spoke before David, we’ve got about nine projects, so I think it became a little bit of a management headache for us – but we don’t regret the numbers of projects we’ve got – was a mental health support programme for care leavers between the age of 16 and 25. And obviously, the whole issue of care leavers has been in the news recently. And this is the only council-based project that we had within the fund, all the rest were voluntary sector. And this was really about training people who were care leavers to be peer mentors to support other care leavers. So the idea was to provide a kind of broad range of kind of themes, sessions that the care leavers identified as being important to them. So again, there was stuff around relaxation, yoga, mindfulness, physical activity, and kind of regular contacts, regular opportunities to come and eat together like a Sunday meal, you know, so that really important stuff; every day stuff, but I think what I call the ‘water of life’ stuff. And a residential, again, to try and build resilience and skills. And the numbers for this have been quite modest, but probably as Angela will bear out, it’s not just purely about numbers, it’s about impact. So that was the kind of second bit of work that we did, and I think that work with the care leaver service will carry on into the future. We had about six peer educators trained. We lost a few of them, but when I say lost, they went on to gain employment. So in a way, again, that was a positive outcome for that particular project. So those were the two that I wanted to highlight.
David Woodhead: Really interesting. Let’s pick up on this thing about impact. Because I can see you nodding there, Angela at various points when Graeme was talking. And I’m just thinking, you know, if you’ve got any sense of the impact that your projects have had, and what kind of impacts do you think, I mean, are they always the impacts that you expected? I like this idea that, you know, on paper, it looks like you’ve lost a couple of your mentors, but actually, they’ve gone on to do bigger and better things with their time as a direct result of being involved in the programme. So that should still be registered, that should still be marked up as a positive outcome, shouldn’t it? Anyway, Angela, I’ll stop talking, please talk?!
Angela Burns: Yeah, I think I mean, definitely, for each of the projects that I mentioned, there’s been positive feedback from the people that have been involved. And some of it is sometimes even just talking about issues that those groups might not have considered talking about, there’s quite a bit more discussion about mental health, that wasn’t happening before. And people also finding new connections that they hadn’t had before. I think it’s different seeing it as a number on an Excel spreadsheet, ‘okay, this many people had this many connections’, but in reality, that probably means a lot for each of those individual people. So that I guess in terms of the outcomes, but also I think wider impacts have been around like enabling space to try to do things a bit differently, and build a business case for further funding, whether it’s from like, huge, or OHID funding one day, but also, like, funding from the public health team. I think that’s been really useful to kind of finally have resource to do more than just coordinate strategies and plans with groups. And yeah, so I think that that for Tower Hamlets, and probably a lot of other local authorities has been really beneficial.
David Woodhead: That’s really, really interesting. Yes. And I mean, I suppose the question is, how do you hang on to that knowledge? Because, you know, I mean, I’ve been around for quite a while. And I’ve kind of noticed that every time there’s a major initiative, it’s like we start from the beginning, again, and how do we keep that knowledge and hold it and take it forward?
Angela Burns: One of the examples of that we’ve started a new community of practice that didn’t, it was kind of in the fledgling stage before, but around the trauma-informed work, there’s been so many people that have been participating in this training, but like, not wanting to leave it hanging or not wanting to kind of let it just stop there, having a platform for those people to continue interacting and learning. And that’s the kind of thing that doesn’t necessarily need a lot of funding to continue. It’s, you know, just something to kind of continue the momentum from the funding that we’ve had.
David Woodhead: I think that’s interesting, isn’t it? There’s this broader point around, keeping things sustained. And keeping them going. And so you said Graeme with that with the mentor programme, that actually you think that the council will keep that going somehow. And of course, one way of keeping stuff going is that in things like a community of practice, I imagine that people will continue to participate, as long as it’s useful, and it’s fresh, and it’s bringing new ideas. But there is a context, isn’t there of restricted resources. And I’m just wondering if you have any reflections on what you’re doing to try and keep some of this going beyond the end of the actual fund?
Graeme Greig: I think it’s a it’s a good point. Just briefly going back to Angela’s point. I think she’s absolutely right, this, for us having some additional resource to actually try some new things in South Tyneside was fantastically positive. And an opportunity to build on some existing projects, actually put more capacity in where we knew there was a need, again, was really helpful. I mean, I think, just if you go back to your former question, I think, yes, we’ve got the numbers for the beneficiaries and all that sort of stuff. But actually, we have a little steering group meeting where we have all the voluntary sector organisations and the council there. We’re doing a local evaluation, a lot of that will be based on case studies. And you can see from the case studies, the difference it’s made to people’s lives in terms of their positive emotions, their engagement, their confidence, you know, they’ve achieved things for themselves they didn’t think they could achieve. They are called ‘softer’ outcomes, but they’re not in a way, they’re all the types of things that make a life worth living aren’t they, that gives your life meaning. So for us, I think, I don’t want to get too hung up purely on numbers. They are important, but I think there were so called softer measures are, I think, equally important. I mean for us as an area, what we’re trying to do is get our local evaluation sorted out and try and… we wouldn’t want to keep everything going because I don’t know it’s been like for Angela, but for us, some things haven’t really worked. And there’s been a whole range of reasons why they haven’t. But I think we’ve got a number of things that have worked. And what we want to do, and that the fund’s given an opportunity to that in a way, is produce a really good evaluation, and then put this through our Mental Health Alliance and our partnerships and our health and wellbeing board, to show actually, that we’ve met need, an unmet need, in some areas of South Tyneside. And actually, if we can’t continue to do some work, then you know, that that will create potentially a health disparity, a health inequality.
So we’re having some thoughts about the best way to do that as we move forward, we certainly want to take the evaluation forward through our partnerships and show the work that’s been done because I can’t remember in my lifetime working in public health, many opportunities to actually do something like this and then evaluate this type of work in so much depth. Normally, if we contract with a voluntary sector organisation, yeah, we’ll look at outcomes and things like that. But we wouldn’t tend to go in depth with wellbeing scales and case studies, we just wouldn’t do that, because we don’t have the time. So I think this has given us an opportunity to really get under the surface of some of these issues locally, and to see the value of the organisations that have delivered and I think, yeah, we’d like funding. I think, as Angela said, we’d love funding. I mean, it’s a shame the funding isn’t continuing. But I think it’s about what we do with that information moving forward, that I think it’s going to count.
David Woodhead: That’s really helpful. Angela, any reflections on evaluation and sustainability, any further reflections from Tower Hamlets?
Angela Burns: I think it’s really similar to what Graeme’s saying, essentially just trying to squeeze as much as we can out of the knowledge that’s been generated, in order to share it with those groups, like, as he was saying, the health and wellbeing board, our local health and care partnership, so that we can continue to prioritise these issues and that we know what works, or at least things that we can adapt. So yeah, really similar to what Graeme said.
David Woodhead: That’s great. So if I came to you, and I said, from some benevolent source, I’d been given some money to do some similar kinds of projects in an area that I’m working in that also has, like, your two places of work has, deep social and health inequality. And I’m looking for snippets, golden nuggets of advice. What would you say to me?
Graeme Greig: I think it’s that great old Stephen Covey, one of his kind of Seven Habits: seek to understand first, and I think that’s the first thing that I did, was not to make any assumptions about some of the communities that we work with. For me, it was, it was really about seeking to understand and then be understood. And by that, I mean, really speaking to the voluntary sector organisations whose work it is, it’s their bread and butter work, they understand their communities really well. And for me to listen and absorb that, and then have that conversation about what we can do collaboratively.
So I think that’s probably the first thing and I think, I think the second thing is when you’ve got a project that’s ongoing, it’s just keep going back to people who were, I hate that term ‘beneficiaries’, but that’s what we’ve used for the fund, our people, our local people, is to go back to them. And just keep checking as the project’s being delivered that actually, it’s doing what it needs to do for them, and not assume that it is. Because I think, Angela said at the start of the call, mental health can be really straightforward, but I think it must be incredibly complex as well. And people’s needs are extremely variable. So my two things, speak to the voluntary sector organisations, they understand their populations well, work with them to deliver the projects. But keep checking in with the people who are getting the benefit of it, whether it is actually doing what you know, it needs to do, and don’t assume that it is.
David Woodhead: Really, really helpful advice. Thank you. And again, kind of underscores the importance of the relationships. Thanks, Graeme. Angela, from your perspective?
Angela Burns: I totally agree. I do think it’s really important to recognise those relationships as being mutual and that we have a lot to, like, councils or public health teams have quite a bit to benefit from voluntary sector organisations and people, residents or whatever we want to call the people that we’re working with, who hopefully we also include ourselves in that, that there’s a lot to be learned from, like, things that have been tried before where we think it might work, but the communities already know, ‘oh, that we did that before and it fell apart because such and such happened’, and that there’s quite a lot of like skills and strengths and resilience already. So it’s not like, we’re so benevolent, and that we know everything, that just because we read a systematic review about something… And I think on a similar note, it’s also important to, I think, recognise what you bring to the table, both in terms of like, what your professional skills and knowledge are, but also what your biases and preconceptions might be about groups. So just being I think really self-aware, is helpful, in terms of being open minded about what solutions might exist in terms of solving mental health issues.
David Woodhead: Very interesting, almost to kind of seeking to understand yourself as well as seeking to understand others. Really important kind of interaction, isn’t it? Dynamic interaction. Thank you so much, both of you. That’s that’s really helpful. See you later. Bye bye.
Alethea Joshi: This podcast was brought to you by Centre for Mental Health. We’re a charity dedicated to eradicating mental health inequalities by changing policy and practice. If you’d like to know more about our evaluation of OHID’s Better Mental Health Fund, or if you’d like to support us, please visit us at centreformentalhealth.org.uk
