NORTH AYRSHIRE SELF-HARM PROJECT ANNUAL REPORT 1 st April 2013 31 st March 2014
Contents Page Penumbra Penumbra Overview 3 Penumbra Updates 4-6 Penumbra I.ROC Overview 7-9 Area Area Updates & Local News 10-11 Service Service Overview 12-13 Service I.ROC Overview 14 Staff 14 Service Users Demographics 15-20 Feedback 21 Recovery Stories 22 Plans for the future 23 Acknowledgements and thanks 23 Contacts 24 penumbra.org.uk 2
Penumbra Overview Penumbra is an innovative Scottish mental health charity, working to improve mental wellbeing across the nation. We provide a wide range of services which offer hope and practical steps towards recovery. Penumbra campaigns to influence national and local government policy, and to increase public knowledge and understanding about mental ill health. We work to PROMOTE mental health and wellbeing for all, PREVENT mental ill health for people who are at risk and to SUPPORT people with mental health problems. Penumbra is seen as one of the most significant mental health voluntary organisations in Scotland. It is known for the quality of its work, its creativity and ability to work in partnership with a range of organisations and groups. Penumbra is a partner of national programmes such as see me' and the Scottish recovery Network www.penumbra.org.uk Penumbra s services include: Supported Living Offering recovery focused practical & emotional support to meet people s needs in their own home. Nova Projects Wellbeing projects that promote recovery, social inclusion and self management. Supported Housing A variety of supported accommodation/tenancy projects. Homelessness Service practical & emotional support for people who are homeless/at risk of homelessness. Plan2Change Peer Support Services Short Breaks Supportive breaks for guests to focus on their recovery. Self-Harm Projects Community based projects for both adults and young people who self-harm and are risk of suicide ARBD Recovery Focused support for people with Alcohol Related Brain Damage. Employment Support For people who are working towards/need support in employment. Young Peoples Projects Services that focus on support for young people. POWOWS Penumbra workshops on wellbeing. penumbra.org.uk 3
Penumbra Updates Penumbra s Nova Short Breaks service was established to provide flexible and PERSONALISED short break and respite opportunities for adults and young people who have mental health problems, and their families and carers. As a national service, they offer supported breaks around the country and possibly abroad, as well as a variety of wellbeing workshops, creative workshops, and day break opportunities. This includes the option to have supported breaks where you live, which could include support for you and your carer(s). At Nova Short Breaks we recognise that people who have mental health problems should have access to the same type of short break experiences that anyone else does. We will support you to explore choice and have access to breaks that are best for you and reflect who you are as an individual. We will work creatively with you to identify what type of short break/respite experience is important to you. We will help you to explore choice, and identify what a break means to you. In addition to the option of building a break from scratch, we plan to offer a timetable of various package break options throughout the year eg city break, relaxation, outdoor activity, health and wellbeing amongst many others. Appointment of Quality and Improvement Officer Julie Rutherford was appointed into her new role of Quality and Improvements officer in July 2013. What does a Quality and Improvement Officer actually do? My role covers three main areas: service audits; policies and EFQM. The service audits will be used to highlight and share good practice across Penumbra and look for areas of improvement. I will be reviewing and updating Penumbra Policies and facilitating Penumbra s journey toward excellence utilising the EFQM Model penumbra.org.uk 4
Our Chief Executive, Nigel Henderson, spoke to the SSSC regarding our successful staff conference which took place over two days in November 2013, at Crieff Hydro. Every two years, Penumbra hold a staff conference which allows for a time for staff to meet up from across the organisation, to hear what is happening in our services and to prepare for new challenges. We try to make these as participative as possible. However we can only take about 100 of our 350 staff to each event and so there are many who can t attend. After discussion with the SSSC, this year we were able to offer a more inclusive opportunity for all staff to participate in some way. Creating the ideas website a month in advance gave all staff the chance to contribute. Our conference is held over 24 hours from 4pm the first day to 4pm the next. We were all ready on day two for a prompt 9am start. We were delighted to welcome the SSSC team and freelance designers and immediately found ourselves pitched into a lot of activity. Throughout the day there was a constant buzz as each of the eight themes were worked on by groups of staff. The themes reflected new ways of working, new uses of technology and identifying new opportunities to enhance community mental health and wellbeing. The designers gently guided us through each of the steps as we imagined the product or service we were designing. Creating personas for the people who we felt would benefit from these, building a business case and developing a creative service innovation (CSI) board and finally making a presentation to the whole conference covers just some of the activities. We had some very creative CSI boards and some wonderful presentations. At the end of the day we all voted for our favourite ideas. The top three will now be taken forward as pilot projects over the next year. Since the conference we have had discussions about the project planning and implementation groups to take each idea forward. These will be firmed up and commence in the new year. Looking back, I would say that the whole process was highly participative, it enabled staff from all levels and functions within the organisation to take part equally and genuinely empowered people to contribute positively. The feedback has been fantastic as people felt very much part of a process that was inclusive and exciting. Our objectives for the event were: participation, a sense of belonging to a creative and innovative organisation, to feel positive, energised and enthused for future opportunities and to network and get to know people from different parts of the organisation. I know we achieved all these objectives! We are committed to following through with the winning ideas and would commend this way of developing ideas and engaging staff. SSSC News, January 2014 Edition penumbra.org.uk 5
Penumbra continue to work alongside local councils and support our supported people, with the introduction of self directed support and direct payments. The new legislation has been put in place to allow those who use social work services, manage their own assigned budget, in a way which they feel will be most beneficial to their needs. SDS Champions Group Penumbra co-ordinates and hosts a user-led Self Directed Champions group (since October 2010) which although local to the West area of Scotland have worked together on projects which benefit supported people, professionals and organisations in a national context. Self Directed Support Event 2010 & 2012 Self Directed Support DVD (DVD directed by the Champions - 2500 copies produced and disseminated across Scotland) Informative SDS material (SDS guides and easy read booklets published. Narrative Project: collaborative project with Scottish Recovery Network and Mental Health Foundation working together to collect and present the stories or narratives of people with lived experience of mental health who are taking more control over the way they receive services through Self-Directed Support. Pop Up Cafes Penumbra launched its first pop up café to allow the general public to access information on Self Directed Support. This took place in Wishaw and there are plans to have more pop up cafes nationally. Self Directed Support Hub Central SDS hub which functions as an information and research centre from which SDS materials and information can be disseminated and events, training and development work co-ordinated and organised. Telephone point to receive incoming enquiries about SDS (0141 221 5571). Members: SDS Project manager, West Area manager, Personalisation Advisor, West Area administrator meet fortnightly. penumbra.org.uk 6
Penumbra Outcomes Penumbra developed I.ROC as a means of measuring the recovery journey of people who use our services. I.ROC is based on Penumbra s HOPE Model: Within I.ROC there are 12 indicators of well-being - 3 for each of the 4 areas of HOPE. It is Penumbra s aim to improve the well-being of people that use its services by having a positive impact in each of the indicator areas. In order to achieve this outcome we developed I.ROC as a means of measuring the impact we were having, and therefore mapping the recovery journey of people who use our services. I.ROC consists of 12 questions, 1 for each of the indicators of well-being. For each question a score is given 1-6. These scores are recorded, identifying priorities for inputs, and then I.ROC is completed on a 3 monthly basis to establish recovery. Each I.ROC question has a combination of verbal and visual prompts and comprehensive guidance on how to facilitate the IROC selfassessment questionnaire is available. HOPE Toolkit contains a range of tools, tips, techniques and resources related to wellbeing penumbra.org.uk 7
Penumbra Outcomes The graphs below represent an analysis of sample data gathered as part of the validation of I.ROC. Analysis is based on first and latest I.ROC scores per person and is presented firstly for Penumbra as a whole, then on subsequent pages, for individual Penumbra Services. Data has been gathered 2009-2012. Penumbra n=486 Penumbra n=486 penumbra.org.uk 8
Penumbra Outcomes Penumbra s overall impact: Penumbra n=486 Total Difference = +2716 Average Per Person = + 5.6 penumbra.org.uk 9
Area Update This has been a year where in the West, we have spent a lot of time concentrating on the development in service delivery, through out this report, you will see examples of both organisational and service specific work, which shows how we are moving and adapting to embrace SDS in all our work activities. In North Ayrshire we have been working alongside partners to take forward work around the Ayrshire selfharm guidance, which you will see throughout the report. The 3 strands to the local contract are developing in some surprising ways and again this will be reported on in this text. The I.ROC scores and graphs are a clear indication of the difference our work here in North Ayrshire is making to the people we support and how we help to build resilience in people who self-harm, people who work in this area and colleagues across Ayrshire. From an area perspective North Ayrshire continues to participate fully in activities E.G. as a member of our national Self-harm group (which agrees the organisational response) to looking at patterns and trends identified while working in 1:1 sessions. We have been very fortunate that some restricted funding donations have been made to North Ayrshire to support our work and we will report on what it has helped us to develop in the next annual report. Our thanks and appreciation go to all those who have supported our cause. Finally I would like to give my thanks and gratitude to all supported people, participants and especially to our Development Worker in North Ayrshire for a productive, busy year. Enjoy reading what the service has been doing this year. Fiona Tall West Area Manager penumbra.org.uk 10
Local News Launch of Guidance In September 2013 the Ayrshire multi-agency guidance for people working with children and young people at risk of self-harm or suicide was launched. This guidance aims to support staff across all partner services to provide a caring and appropriate response to children and young people experiencing emotional distress and who may be at risk of deliberate self-harm or have thoughts of suicide. This document was adapted from the North Ayrshire guidelines for social services staff supporting accommodated young people which were prepared by Sarah Watts, Choose Life - Implementation Manager (North Ayrshire) Social Services and Health. (Supporting Accommodated Children and Young People at Risk of Self-harm and Suicide - November 2012.) These documents were founded on work done by Penumbra. Penumbra was also actively involved in the launch of both of the above documents. The service (Helen Gibson) had previously accompanied Sarah Watts in visiting several residential children s units to discuss the guidelines for social services staff. In addition, Fiona Tall, Area West Manager, Penumbra and The service assisted at various twilight sessions (hosted by Choose Life) for agencies in North Ayrshire. penumbra.org.uk 11
Service Overview The North Ayrshire Self-harm Project is part of Penumbra s self-harm services which are community based projects for both adults and young people who self-harm and are at risk of suicide. Penumbra currently has four self-harm projects based throughout Scotland. In addition to supporting people who self-harm these projects also aim to increase awareness of self-harm issues and reduce stigma of self-harm. The North Ayrshire Self-harm Project was set up in in January 2005, with initial funding from Choose Life to work with young people aged 16-25, their families and professionals around the issue of Self-harm. In April 2013 the project successfully secured three year funding from Choose Life which has enabled the project to widen it s remit to allow us to provide support to people over 25 years. In addition the project can now provide information and expertise to assist teams in developing good practice. The project s new Aims, Objectives and Outcomes of the Service are as follows: Aims Objectives Outcomes Provide and promote individual self-harm coping strategies and an understanding of the triggers for self-harming behaviour Provide awareness and understanding of self-harm and the issues associated with it for individuals, families and workers To reduce self-harming behaviour and minimise harm Increase the community of understanding around those who self-harm To provide one to one support directly to those who are self-harming and support them to minimise risk, manage their self-harm and develop alternative coping mechanisms To raise awareness of the issues for anyone who might come into contact with someone who self-harms and to enable them to understand and support individuals more effectively To identify and enable access to further training needs for teams and individuals Appropriate and practical workplace strategies can be put in place which provide a consistent and safe approach to dealing with self-harm which minimises risk By providing appropriate and sustained levels of support for individuals to manage and reduce their self-harming behaviour and at the same time providing awareness and understanding of the issues and management of self-harm, it is hoped that fewer people will increase their patterns of self-harm and therefore reduce the risk of suicide. penumbra.org.uk 12
Activities North Ayrshire Self-Harm Project Launch of Ayrshire multi-agency guidance for people working with children and young people at risk of self-harm or suicide (September 2013) As mentioned above this year the Development Worker, (Helen Gibson) and Fiona Tall the West Area Manager have actively supported Sara Watts, Choose Life Implementation Manager in the launch of the above guidance. We have provided support at various twilight sessions held in North Ayrshire. We have also raised awareness of the guidance. In addition, the Development Worker has accompanied Sarah Watts, in visiting children s units within North Ayrshire to discuss the guidance. Inside Out Drama Project The Development Worker played a support role in the Inside Out Drama Project (a collaboration between partners including; Ayr College, Ayrshire Anti-Stigma Group, NHS Ayrshire and Arran, see me, Choose Life, third sector organisations and Education). This involved attending a performance at Arran High School and facilitating a discussion on stigma with a group of S5 pupils. School Involvement The Development Worker has been actively involved with schools within North Ayrshire. This has entailed: Providing self-harm workshops to S6 pupils at Garnock Academy Providing good practice advice and training to guidance/support staff (see below for further information) Providing self-harm awareness training to Extended Outreach Staff Good Practice The Development Worker has been involved in supporting Largs and Garnock Academies to develop good practice in dealing with self-harm. This has involved developing and piloting tools to assist them in dealing with self-harm. She has met with Evelyn Irvine (Largs Academy School Nurse and Linda McIlvain School Nurse at Garnock Academy). As a result she has developed and successfully piloted the following tools with Guidance and Support Staff in Largs and Garnock Academy: Self-harm Flow Chart Safety Plan Case Studies penumbra.org.uk 13
.Service I.ROC Updates The majority of the indicators have increased with the highest change being in physical health followed by participation and control. The smallest changes were in mental health and personal network. Life skills score remained the same which reflects the fact that the majority of our Service Users had quite a high score in this category to begin with. Service Outcomes Staff The project is run by Helen Gibson, Development Worker who is employed on a part-time basis and Fiona Tall, West Area Manager has overall responsibility for the project. The project is based in Ardrossan Youth Centre in Ardrossan. Helen Gibson provides one to one support, self-harm awareness training and good practice advice to teams. penumbra.org.uk 14
PEOPLE THAT HAVE USED THE PROJECT Since 1st April 2013 a total of 192 people have used the service. We have delivered 14 Self-harm Awareness Raising sessions to various groups including professionals and groups of young people. We have provided advice/information to 4 professionals who contacted the project. We have delivered 565 hours of one to one support. In addition, to the one to one support we have also provided informal support to 13 parents/carers/friends of Service Users. This year the project experienced a slight increase in referrals (2%) on last year. The breakdown of who used the project is as follows: Total numbers who used the project Referrals 34 Training and Awareness Raising for 80 Professionals Young People s Workshops/Awareness 61 Raising Parents/Carers 12 Professionals 4 Friends of Service Users 1 Demographic Information of People Referred To The Project Age The majority of referrals received (approx. 36%) were for people under 16 years of age which is similar to last year and not surprising given the increase in self-harm in this age group nationally. There were also a significant percentage of referrals (24%) in the 16-17 year age which may reflect the uncertainty regarding changes to this age group (i.e. leaving school/care). This year was the first year that we accepted referrals for people over 25 years and 15% of our referrals were in this category. We anticipate that this percentage will increase next year due to an increase in awareness of the fact that we now also support people over 25. penumbra.org.uk 15
Gender As per previous years the majority of referrals were pre-dominantly female (91%). This year the percentage of male referrals decreased slightly by 7% compared to last year. However, this wide gender split is in keeping with Penumbra s self-harm projects Scotland wide and is also backed up by anecdotal evidence from school nurses and education staff in North Ayrshire. penumbra.org.uk 16
Area This year we received the highest number of referrals from Ardrossan followed by Dalry, Irvine and Stevenston.. ISSUES AFFECTING PEOPLE REFERRED TO THE PROJECT The issues underlying self-harm with which people to the project present with are often complex and of varying degrees of severity at different times, e.g. periods of anxiety and depression, temporary homelessness and drug or alcohol issues. In addition, they can have a number of issues. It can, therefore, be quite challenging to pinpoint the specific issues that have led people to use self-harm as a coping mechanism. When the assessment is completed the worker asks people to identify the issues they themselves feel most important to focus on. In common with previous years the main issues affecting people include family breakdown (58%), bullying (55%) and bereavement ( 55%). However, The service has again noted a high percentage of people with eating issues. In the majority of cases this is related to negative body image. This year we saw a 30% increase in this category compared to last year. Furthermore, 65% of girls aged eighteen and under had such issues. However, it would appear that this is not just a female issue as it affected a similar percentage of males under eighteen. Unemployment continues to be a common issue for people aged over 18 years of age with a 14% increase compared to last year. This increase might be due to the fact that we have increased our age limit. penumbra.org.uk 17
The project has also experienced a considerable increase (29%) of Service Users with drug and alcohol related issues which again may partly be explained by the increased age limit. In addition, there was an increase (14%) in the number of people who had experienced domestic abuse. SOURCES OF REFERRALS As in common with previous years the highest number of referrals came from NHS (Health) with 32%. Although the percentage of referrals received directly from NHS has decreased for the first time, this year we have noted an increase in referrals in the Other category which have been signposted from NHS. This year s health referrals have included Community Adolescent Mental Health Service (CAMHS), Psychiatric Liaison Services, Psychologist and School Nurses. This is followed by Other at 24% which includes Independent Community Organisations and Parents/Carers. This year referrals received from Social Work (15%) represent an increase on last year. These referrals include referrals from Social Workers and staff from Addiction Services. This increase from Social Work appears be due to increased awareness within Social Work of our service and the fact that we now support people over 25 years. penumbra.org.uk 18
Referrals received from Education (6%) represent a slight decrease from last year. It is interesting to note that over the last two years referrals from Education have been steadily decreasing. Given the significant increase in self-harm in 12-16 year olds this is surprising. However, this may be explained by the fact that school staff is becoming more experienced at dealing with self-harm. Self referrals have decreased considerably this year compared to previously although we are unsure as to the reason why. This year the project received 6% of referrals from Criminal Justice Service as a result of the launch of new Criminal Justice Services locally. REFERRALS RECEIVED PER MONTH Historically referrals can fluctuate over the course of the year.. The number of referrals received in December, January and February can often be lower than the rest of the year. In addition, referrals can be lower in the high summer months (July/August). It is difficult to determine if these lower rates are due to a decrease in people s self-harm at these times, or the fact that referrers are on annual leave and/ or it coincides with a quieter time for their services. penumbra.org.uk 19
CHALLENGES FACING THE PROJECT This year we found that as there is an increase in young people self-harming this in its self builds a demand that needs to be considered in how to support parents, particularly when the young person is under 16. Currently, although the service is not funded to do this, we do offer informal support by phone. It s perhaps an area to consider for future work. This coupled with additional time taken to travel to and from relevant meetings pertaining to the individual could have an impact on the service. We would like to see development around support for parents/carers, which would increase their resilience in supporting their relative through a difficult time in their lives. penumbra.org.uk 20
Service User Feedback: The support really helped, it s worked. I wish I d come for support sooner. It s guid. If it wasn t for support at Penumbra, I am sure I wouldn t be here, it s as simple as that. It s really worked; my teachers have noticed and asked me what I have been doing as my behaviour has improved so much. My friends have also said that I am much better company now. It is really good, it does really help. I liked the Safety Plan and the list of alternatives to self-harm. Feedback from Self-harm Training Staff that were new and knew very little about self-harm felt it was delivered well and was very informative. They feel they will be more confident and knowledgeable when dealing with self-harm. They also felt there was a lot of discussion generated and felt more experience staff helped by sharing their knowledge about what approach they took when dealing with self-harmers. As for myself as a ten year serving staff member I also came away with new knowledge and awareness of stuff that I never knew about people that self-harmed. All info was informative, good refresher. Thank you. Excellent both professionally and personally. I feel much more comfortable and have a greater awareness and understand of issue. The training was very interesting and relevant to us. Thank you. A clear and easily understandable presentation Changed my understanding and how I will deal with this in future. Feel more prepared to recognise signs and causes of self-harm. Very useful considering it was awareness now have a better understanding. Will be more comfortable speaking to anyone who self-harms. It is still a difficult issue to deal with, but I do feel a lot more confident. penumbra.org.uk 21
Recovery Stories Mandy s Story Mandy was referred to the project as she was self-harming and was interested in support to help her stop. Mandy attends a college course part time and also does voluntary work. Although she regularly meets people in the course of these activities she does not have any friends of her own. This makes her feel lonely and gets her down. She also has low self esteem as a result of bullying. The following diagram illustrates the changes made by Mandy as a result of her one to one support: Thanks to the support from Helen at Penumbra my life has improved. I now have more friends and good things to do. I haven t self-harmed since I started coming to Penumbra. penumbra.org.uk 22
Plans For The Future The project plans to roll out the tools which have been successfully piloted in two secondary schools to other interested secondary schools within North Ayrshire. In addition, some of these tools may also be of interest/use to other organisations within North Ayrshire and we intend to develop this aspect. It is anticipated that there may be an increased need and interest in the use of practical tools from other organisations/teams which are involved with young people. The service intends to build on the existing strong relationship with schools in North Ayrshire. The project anticipates increased awareness of fact that we support people over twenty five years and an increase in referrals from this age group. Acknowledgements and Thanks We would once again like to thank Choose Life and for their on going support and enabling the project to continue to have a presence in North Ayrshire. This has allowed us to reach out to local people, raise awareness with staff of many organisations and agencies about self-harm. Our thanks and appreciation goes to Sarah Watts, Choose Life Implementation Manager for this valuable role. We look forward to continuing to work together with Choose Life. We would like to thank the School Nurses from Largs (Evelyn Irvine) and Garnock Academy (Linda McIlvain) for their valuable contribution to the development of the new self-harm tools for schools. We also offer our thanks once again to the Committee at Ardrossan Youth Centre and to Alison Montgomery, Youth Worker with North Ayrshire Council, and Education Youth Services for their continuing help and support. Finally, and most importantly, we would like to thank Mandy our service user for kindly allowing us to include her story. Thanks, Mandy this is much appreciated. penumbra.org.uk 23
Contact Details Service: North Ayrshire Self-harm Project Penumbra Ardrossan Youth Centre Stanley Road Ardrossan KA22 7DH Tel: 01294 471934 Penumbra West Area Office Room 408 Pentagon Centre 36 Washington Street Glasgow G3 8AZ Tel: 0141 229 2580 Penumbra Headquarters Norton Park, 57 Albion Road, Edinburgh, EH7 5QY Email: enquiries@penumbra.org.uk Tel: 0131 475 2380 penumbra.org.uk 24