Nagas evaluation report 01 09 11

Newcastle & Gateshead Art Studio Creativity ~ Improving Mental Health

An Evaluation of Newcastle & Gateshead Art Studio

Painting by studio user

“NAGAS is a critical stepping stone on the pathway to mental health recovery�

Referring Agency

Evaluation Report A review of the Newcastle & Gateshead Art Studio Summary This report reviews the delivery and impact of the Newcastle & Gateshead Art Studio in 2008-11. The charity provides an innovative range of creative based services targeted at individuals experiencing, or at risk of, diagnosed mental health issues. Through studio-based and satellite art activities and opportunities, NAGAS aims to improve and enhance the quality of life, health, wellbeing, and social integration of its members. Essentially a qualitative review, the exercise involved interviews with service users, project staff, and external agencies. It also drew on background documentation and internal reviews undertaken by NAGAS.

CONTENTS Executive Summary

3

SECTION 1 - BACKGROUND Methodology

6

Context

6

Project History, Model, & Delivery

7

SECTION 2 - IMPACT An External Perspective

10

A User Perspective

14

A Project Perspective

19

SECTION 3 - A SUMMARY Conclusions

21

Appendix 1 - Contacts

25

Appendix 2 - Trustees Appendix 3 - NAGAS Client Group

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Executive Summary Background  Newcastle & Gateshead Art Studio (NAGAS) is a community based arts organisation that supports the recovery and well being of people with mental health problems. The client group is broad and includes: people living in the community with mental health and well-being issues, patients discharged from a local mental health unit, homeless people in supported living, people suffering a bereavement, asylum seekers, and individuals with both mental health problems and a learning disability.

Brief and Methodology  The evaluation was commissioned by NAGAS and was undertaken by Carol Meredith Consultancy Limited over eight days in June-August 2011.

This essentially qualitative evaluation is a response to the brief to examine the need for, and impact of, the Studio’s services for people starting on a pathway to recovery from a period of mental health problems.

• The evaluation brief from NAGAS focused on three key

issues:

“NAGAS gave structure to my life” Service user



 the

difference/impact NAGAS members  the need for the project  examples of good practice

makes

to

its

The evaluation explored impact from a qualitative, service user, and stakeholder perspective. Semi-structured interviews were held with service users and representatives from referring agencies, staff, sessional artists, carers, and a volunteer. The evaluation also undertook desk-based analysis of materials and reports provided by NAGAS including a previous external evaluation.

The Need for the Service  There was overwhelming endorsement of the quality, appropriateness, and need for the type of support that NAGAS provides. 

Feedback from both users and external agencies confirmed that the studio clearly meets the needs of people with mental health problems taking their first steps back into society. Its semi-structured approach provides a supportive environment for individuals unable to cope in formal settings with expectations of results-focused activity.

• There was a consensus of opinion on the need for a semi

structured, creative environment where people could take

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their first steps back into society and start to take responsibility for their wellbeing. Agencies noted how NAGAS offers a framework with flexibility that is a vital alternative to the more circumscribed and output focused activity that people at the start of their mental health recovery cannot initially accommodate. 

NAGAS fits with current health policies by offering constructive and supportive community-based services rather than the former model of traditional day services for people with mental health problems. Agencies recognised that without the NAGAS model of support there will be a critical gap in provision. The backdrop of limited community based resources for people with mental health problems in Newcastle was highlighted as projects close and are replaced with more structured activity programmes.

Model  The evaluation confirmed that the art studio model of Engagement, Participation, and Development encourages user-led progression. Interviews with users illustrated how studio support helps them create structure in their lives, make decisions, find motivation, interact with other users, and move towards personal recovery from their mental health problems.  “The art brings everything together socialisation, personal development, communication skills” Referring Agency

Benefits identified by users and external agencies included:  a safe space  a therapeutic environment  a starting point for their pathway to recovery  a structure that suits their needs and lives  an opportunity to try new, creative activities

Delivery • NAGAS offers an extensive array of creative activities each week - multiple art forms, music, creative writing - to people with mental health needs. This is achieved with limited resources assisted by volunteers.

• The range of referral sources was broad, and included self-

referral, which suggests a high degree of accessibility by people from across the spectrum of mental health disorders.

• User involvement - and the perception by users that they have a voice in the running of the studio - indicate s a level of

engagement that many statutory mental health agencies struggle to achieve.

• There was evidence of added value through the social

inclusion created by bringing together people from different

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backgrounds and experiences.

• The evaluation confirmed that NAGAS provides a critical, successful, and appropriate, community based service in the views of partner agencies and service users.

“I cannot speak highly enough of the Art Studio” Team leader Referring Agency

Impact • The evaluation showed the substantive difference that NAGAS makes to its members through their involvement in studio activities and outreach sessions. External and user feedback particularly noted: • social capital - friendship groups, teamwork • improved verbal ability and communication • prevention of relapse and the “revolving door of hospital admissions” • increased skills and abilities • improved confidence and self esteem • The review found examples of positive progression outcomes relating to volunteering, employment, and education. Service users have become volunteers in the studio and with external agencies, taken up mainstream education courses, joined structured groups , and gained employment within the Studio.

• Personal progression was evident through increased confidence and achievements such as public speaking and working as a team to produce and deliver exhibitions.

• From an external perspective, interviews demonstrated consistent findings associated with the high quality of NAGAS’s provision and high levels of user satisfaction from the clients they referred to the studio.

• The Studio’s atmosphere, model, and approach acts as a preventative tool, helping to stop the revolving door of hospital admissions by providing the semi-structured, supportive environment that people need in their early days of mental health recovery.

Management • Feedback, particularly from external agencies, highlighted the intrinsic link between the Studio’s model and the calibre and style of the two staff.

There was a significant acknowledgment of the skills and ability of staff who have developed a truly accessible and supportive community based service for people starting their recovery following a period of mental health difficulties.

• There was also evidence of a robust internal management approach of regularly consulting with users and reviewing

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the effectiveness of the Studio’s work.

Good Practice • Examples of good practice were found in all aspects of the Studio’s delivery - from initial development work using outreach sessions to build relationships and engage users, to the design and layout of the studio to cater for a wide audience with varied needs.

User involvement was promoted through an advisory group with representatives at board level, whilst staff and volunteers had robust backgrounds and experience in the fields of both the arts and mental health.

Significant intellectual property and invaluable experience has been built up by the studio.

Future Direction • NAGAS has previously done development work to engage with black and minority ethnic communities but this has proved problematic. The charity is now working with The Medical Foundation to develop a project identifying acute mental health issues suffered by victims of torture.

• NAGAS has already invested time in development work to explore a range of funding and income generating options to ensure longer term sustainability. This is being supported by partnerships with ACEVO and Newcastle University as the charity has been identified as an exemplar project. Liaison is ongoing with local authority and PCT commissioners as NAGAS has systems ready to pilot personalised budgets.

Methodology • The evaluation was commissioned by NAGAS with funding

from Northern Rock Foundation. The work was undertaken

by Carol Meredith Consultancy Limited over a period of eight days in June-August 2011.

• The evaluation brief from NAGAS focused on three key

issues:

 the

difference/impact NAGAS members  the need for the project  examples of good practice

makes

to

its

• The evaluation brief also considered:  how NAGAS can improve its service and working practises  key issues arising from the research to inform

6

the business plan  A predominantly qualitative evaluation approach was adopted to identify outcomes based upon participants’ and stakeholders’ views and experiences.  A variety of methods were used to contact key individuals, staff and agencies to gain a view from stakeholders on the impact/effectiveness of the project:  desk-based research using previous reports, the charity’s website, recent internal and external evaluations, and policy documents  a survey of service users  semi-structured interviews with key stakeholders from the organisation - service users, carers, volunteers, referring agencies  meetings with project staff  analysis and report writing

The Context • The North East displays some of the highest rates of mental illness in England. Data from the Health Survey for England shows that the North East is the only English region with an estimated prevalence of possible psychiatric disorder of 17.5% (measured using the 12-item General Health Questionnaire). This is significantly higher than the England average of 13.2%.

• The region has the highest age standardised death rates from suicide and injuries of undetermined intent in both males and females aged 15 and over. The rate for males 20.4 per 100,000 - is significantly higher than the England average (16.4 per 100,000).

• The North East also has the highest age standardised rates of hospital admission for self-harm and for drug overdose.

Rates are significantly higher than the England average. 1 7

•

A survey of the prevalence of common mental health issues showed Newcastle was rated 22nd (Gateshead 67 th) of out 336 local authorities across England (2006).

A Brief History of Newcastle and Gateshead Art Studio (NAGAS)  Newcastle & Gateshead Art Studio was formed Jan 2004  Development Worker employed Dec 2005  Start of outreach sessions within the community Jan 2006  Moved into premises and a Studio based service opened Aug 2006  Became a registered charity April 2007  Assistant Manager recruited April 2009

1 http://www.nepho.org.uk/topics/Mental%20Health 8

The Model Vision & Mission • Newcastle and Gateshead Art Studio provides an innovative range of creative based services aimed at improving and enhancing the quality of life, health and social integration of its members. Studio and satellite-based activities provide opportunities for those who are, or at risk of experiencing diagnosed mental health problems, including those with both mental health and learning disability.

“Residents return from the Studio with a “buzz” and a smile on their faces from the therapeutic environment where they are able to socialise” Referring Agency

• With a mission to, “Provide a Service that Engages Members

in Creative Activity”, the Art Studio provision enables service users to: - be engaged in creative activities - develop skills with or without support from professional artists - be supported to become integrated into the group and make friends - display artwork online via NAGAS website - be given choices exhibit work externally - be supported to move on - work independently and in groups - influence change

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• NAGAS works to develop members’ ability to challenge and take responsibility for

their own mental health. The charity supports members to develop the confidence to take up opportunities that improve life skills and promote recovery.

The model below demonstrates the charity’s approach.

Stage 1

Stage 2

Engagement Development with

Engagement:

creative & social activity Intervention: in social

Stage 3 Participation

Participation: in creative & skill raising activity Improvement: in mental health, wellbeing & skill Promotion: of creative skills, knowledge and opportunities

exclusion & acute ill-health

Recovery: develop confidence, self esteem and empowerment Signposting: help to seek opportunities towards a more fulfilled life (volunteering, education, training, employment etc…)

relapse Prevention: of

“The best thing (about NAGAS) is the environment.

Everyone is treated as an equal. There is no hierarchy between staff and users” Partner Agency

• As a large open space with tables, and access to a wide

range of arts materials, music, a kitchen area, and library, the Studio is a warm, welcoming space with an informal atmosphere where people work individually or together at large tables.

• The Studio offers open sessions four days a week and a

referral is required. There are no constraints to attend sessions, nor is the studio a drop-in. It is a place where people choose their activity, identify what they want to do, progress at their own speed, and feel under no pressure. It is the process and activity that are important, as the focus of the service, whilst the finished item is almost the by-product of the therapeutic environment.

Delivery  Art studio service four days each week, 10.00-5.00pm, at Blackfriars Centre  1 day music outreach session at The Sage Gateshead

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“He concentrates on the tip of the brush and the voices go into the background” Partner Agency

“Going to the Studio improves people’s lives” Referring Agency

 1 day a week creative writing project ongoing at Blackfriars Centre  A variety of time limited creative projects running throughout the year • NAGAS offers a wide range of creative activities including:

 Painting - oil, acrylic, watercolour, gouache  Drawing - pencil, coloured pencil, charcoal, graphite, technical  Printing - woodcuts, etchings, lithography, screen printing  Inks - water and oil based  Pastels - chalk and oil  Fabric paint - silk, fabric dye, batik  Sculpture - carving tools for wood, stone, plaster, wide range of general tools for wood, metal work  Glass work - stained glass, glass paints oil/water based, kiln glass work  Pottery - red and grey clay with kiln, wide range of glazes  Media - photography, video, animation  Digital - various media based programmes  Mosaic - vitreous, clear, clay  Craft work - card making, felting, jewellery, encaustic work • NAGAS also offers

individual studio space so members can have their own small area to work in, like an artist’s studio, and benefit from a quieter and more reflective space in which to create and develop their art.

• NAGAS uses different methods and approaches to support

studio users:  instruction/education - a member of staff, sessional artist, or volunteer directs and supports a user  guidance - users motivate themselves to produce their own art works, with guidance where necessary  collaboration on a given project - artists support users work together on a project, for example an exhibition NAGAS Management & Communication Structure

NAGAS Board The Assistant Manager has MA, BA and 4 yrs experience of running an Arts Studio

Studio Manager

Account management The Studio Manager has a BA, 10yrs experience of running an art studio, 4 yrs Support work, and 6 yrs Development work

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Assistant Manager Sessional Artists

 Occupational Therapists,

Advisory Group

Members Advisory group The advisory group is a small group of NAGAS members who regularly meet to discuss service provision and to influence the direction of the charity. The meetings are supported by the Assistant Manager and issues raised are passed on to the Manager and board of trustees.

• Staffing presently consists of:

 Art Studio Manager (f/t)  Assistant Art Studio Manager (30 hours)  5 sessional artists  4 volunteers

Impact

Referrals from:

 Community Psychiatric Nurses,  Doctors,  Social Workers,  Support Workers,  Community Health workers,  Other mental health service

An External Perspective

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• This evaluation drew on external views for an independent

perspective of NAGAS. A series of semi structured interviews specifically sought the views of professionals in the field of mental health through contact with a number of referring agencies operating on Tyneside (cf Appendix 1).

Reference is also made to a previous external evaluation in 20092 • There was significant and substantive praise from all the

agencies contacted for the Studio’s work. Referring agencies that had subsequent contact with clients they referred reported high levels of user satisfaction.

“One user we referred had very inappropriate speech and behaviour. Since attending the Studio where he meets and socialises in a relaxed and supportive environment, his behaviour has significantly improved, he is more relaxed and accepting of other people around him, and he no longer sees a psychologist.

The studio is a relaxed and supportive environment and the changes in this individual are at least in part attributable to coming to NAGAS over a period of time”

Self Esteem & Confidence • One agency spoke about the real sense of self and pride that Studio users expressed in their artwork, talking about the sessions they attend and the artwork they create. This was further reinforced by the opportunity to display it in the hostel where they currently live before moving onto independent living.

• One carer reported how the woman she accompanied to

the studio had grown in confidence through the individual support from an artist at the studio who helped her create a memory book of someone close to her who had recently died. Her ability to concentrate had improved, as had her handwriting, as a direct result of the one-to-one support and encouragement.

• A buddying system is used by one referring agency so that

on discharge from a ward, users can attend the studio knowing they will be meeting people they know and are comfortable around.

A Preventative Service • Many people suffering from mental health problems have experienced prolonged periods of isolation and find it difficult to acclimatise to social situations and interact with others.

Moving from intensive clinical support into mainstream activity can be daunting, intimidating, and counterproductive. NAGAS was seen by one agency as the most appropriate and effective agency to prevent the revolving door syndrome of repeat hospital admissions due to a lack of initial appropriate support.

Progression • The Studio often acts as “the first step or springboard that

2 Masters of Social Work 2007 -2009 An evaluation of creative therapies in a city in the north east of England; wellbeing and mental health

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“After mixing with people at the Studio his self esteem has risen to take on new challenges and he is now a volunteer in our charity shop”

builds self confidence and socialisation” was how one support worker described its effect on individuals he had referred. Individuals who initially had no confidence to attend sessions without being accompanied ‘flourished’ as a result of the stimulation of being around other people with similar problems. From being unable to speak to others they developed the confidence to ask a group at their table if they would like a cup of tea - a big step for those who find it difficult to interact with others.

• Agencies see NAGAS as a stepping stone for people taking

“If you try an activity, and develop an interest, other doors open for you” “NAGAS is a nurturing starting ground”

their first steps back into society, as a safe place to explore how they feel through creative activity. It provides a facility to support those with a clear interest and talent, in the arts who see it as an integral part of their pathway to recovery, alongside those who want to use art as a therapeutic tool to move forward in their lives. It provides a normalising situation with peer support, together with opportunities for various activities and involvement - exhibitions, group work, satellite groups eg the music workshops at the Sage, volunteering, and group and one-to-one creative writing sessions .

• One external agency noted the real difference in the verbal

“He’s never had so much contact with people in his life and he thrives on it”

communication skills of one user who had previously been monosyllabic. After socialising and participating in art activities that involved sitting with others in a group situation he now speaks in sentences and his verbal skills are constantly improving.

Best Practice • The studio’s approach to supporting people to develop at their own pace was quoted by many of those contacted. The opportunity for members to work at their own pace and capability, without the constraints or pressures to achieve, was highlighted as both best practice and also a rare model in a world that is increasingly adopting targets and timeframes for even the most vulnerable adults.

• At the same time, it was felt that the studio has a structure

“If NAGAS closes users will stay at home and return to statutory services quicker”

with recognised rules of engagement and behaviour. These sit alongside a flexibility and atmosphere that suits the needs of people with mental health problems who are not ready for structured services or mainstream provision.

• The example of a studio member with Aspbergers was cited,

who cannot cope with the pressure of more formalised classes or situations, and sometimes loses the motivation to come to sessions for several weeks. The semi structured model does not require regular attendance at a prescribed time or create the pressure of achieving within a defined

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timeframe. This flexible system means members can drop out for a while and then return without feeling they are outof-their depth once they return.

• This highlights how NAGAS is able to accommodate “the “NAGAS helps those not well enough to know what they want to do, those who are not well enough to access more mainstream services” “NAGAS is a first step to recovery and rejoining a structure that is off site ie in the community and not stigmatised”

ebb and flow of people’s lives”, so they can return to the studio and seamlessly continue their involvement in creative activities and continue to maintain and improve their mental well being.

• A representative from a community mental health team

cited NAGAS as an appropriate place for many of their clients who cannot cope with mainstream activities as the first stage of their recovery.

• One referring agency commented on several users they had

referred to NAGAS specifically because of the studio environment as it suited people who had not left their home for up to eight years.

• The NAGAS studio offers a supportive environment for those

with long-term, enduring mental health problems who need a community venue that does not place them under additional pressure. The studio meets their needs through its simple rules and clear boundaries.

“The studio is a place where people can be on their own if they are anxious, they can get used to being out of their home for the first time in many years, and they can start to interact and communicate with people again in their own time and without any pressure” “The staff build a rapport and understanding of people” “The Studio is so beneficial to residents who have been homeless as it is relaxing and therapeutic”

Staffing • External partners and referring agencies repeatedly highlighted how the success and impact of the Studio is directly attributable to NAGAS staff. With long experience of working in the field of mental health, and with professional arts backgrounds, they have been able to create a venue that enables users to create a structure in

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“It works. And it’s down to the management of the Studio” “The staff have a way with people”

their lives.

• Their ability to reach and support the most vulnerable

clients is clear from the experience of a female user who feels extremely anxious in the presence of men. Yet she feels able to regularly come to the Studio where she is happy to work alongside male service users and be supported by the male Studio Manager.

• External agencies particularly highlighted the tiny number of

incidents they were aware of happening in the studio despite the range of mental health conditions, and potential for extreme behaviour. They again attributed this to the non-threatening atmosphere with clear boundaries created by staff, plus their knowledge and experience of working in community based settings with people with mental health problems. Representatives of referring agencies also quoted instances of members recognising and responding appropriately when another user had behaved inappropriately, showing how Studio staff had created expectations of behaviour.

• Whilst the Studio has no official classes or set timetable -

staff are vigilant and tuned in to people’s needs, and there is a subtle and nuanced approach to ensuring people are supported. The ability of staff to flag up and maintain clear boundaries within the studio was noted by referring agencies. Members are clear that the art studio is not a counselling service and the Studio Manager has ensured users understand exactly what support is available.

“You can pick up a paintbrush but writing is not so easy to start...”

The creative writing group at the studio was started by an artist, A, who had run a similar group for a userled mental health forum for six years. With a qualification in creative writing, and personal experience of mental health problems, long experience of running creative writing sessions, A set up a similar group for NAGAS. Service users can choose either one-to-one support or group sessions and there is a ‘taster booklet’ to read different writing styles - funny, profound, easy, hard, sophisticated, straightforward, etc. A worked on a one-to-one basis for a year with T, a service user who had been writing poems for 11 years. His collection of poems told the story of his experiences of mental health problems including a stay as an in-patient in a mental health unit, portraying long years of “difficult experiences told from a positive slant”. A supported T to form his collection into a booklet for publication, shaping it into a narrative, discussing a title that

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reflected his image of his life, considering the value of the book for others, and the possibility of what negative feedback would feel like. It was a lengthy, detailed, and careful process that required “a balance between safety and exploration” with “the emphasis being on the process rather than the product.” The end result is a publishing contract!

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A User Perspective • This section of the document outlines the number and type of clients

that NAGAS supports together with users’ views gathered through a survey and semi structured interviews in the studio with individual users.

• At the time of this report NAGAS had 308 members and a new referral

rate of six people per month.

NAGAS Membership & Attendance Figures 2009-2011 July 2010 - July 2011 members attending in 12 month period

178

members attending in 24 month period active members (attending 12+ times)

July 2009 - July 2011 229

71

98

3812

6705

daily attendance

21

21

weekly attendance

81

64

monthly attendance

306

280

separate recorded attendances

“The Studio provides quality support and guidance” Referring Agency

• In addition, the studio supports people with a diagnosis of both mental

health problems and a learning disability. As art, particularly painting, is an activity that people with learning disabilities often enjoy, the studio is able to support a group of 6-8 users who attend the studio regularly each week to meet together socially and take part in creative activities.

• Since the Art Studio opened, BME membership has been 6.1%. In the

previous 12 months BME active members have been 5.17% of the total Studio membership.

• NAGAS aims to provide a truly inclusive service and has recently started

to work in partnership with The Medical Foundation to form links with their victims of torture members, as well as other BME groups.

Statistically black people are three times more likely to be admitted to psychiatric hospitals than the rest of the population. However, day services in Newcastle have registered low uptake from BME communities and NAGAS is looking at how to bridge the lack of understanding around mental health within different communities.

• The pie chart below shows a breakdown of the wide range of conditions that users present with

and that the Studio is able to support. There is a broad spread - from low level mental health problems through to severe and enduring mental health difficulties.

User Feedback • The views and feedback from users were gained through: • a survey designed specifically for this evaluation • interviews with service users, including mini case studies • feedback from an external evaluation undertaken in 2009 • A survey, based on the Warwick-Edinburgh Mental Well Being Scale

(WEMWBS) model, was completed by service users with assistance from Studio staff. It was designed to elicit responses based on users’ perceptions of their well-being since coming to the studio.

• 39 service users completed the survey, seven of whom have both “The Studio ‘feeds’ me and keeps me motivated and productive.”

mental health problems and a learning disability. The chart overleaf shows the responses and highlights the substantive differences to their lives that users attribute to the Studio.

Survey response figures, showing people with mental health problems and a learning disability, are included in Appendix 4.

Service user survey based on the Warwick-Edinburgh Mental Well Being Scale (WEMWBS) model

Since coming to the Art Studio………

Service user survey based on the Warwick-Edinburgh Mental Well Being Scale (WEMWBS) model

Since coming to the Art Studio………

• Informal interviews, using a semi structured interview template,

showed the value of the Studio as perceived by users. It was evident from these conversations that, whether individuals using the Studio have a talent for art or simply an interest, NAGAS provides a recovery mechanism with real social and therapeutic value.

Can I ask you to imagine……. …living in somebody else’s 9 to 5 workplace?

Can you imagine doors are banging very loudly – so much so you want to become deaf?

Can you imagine you’re tired and you can’t get to sleep?

Can you imagine being given relaxants in an environment which is tormenting you?

Can you imagine wanting to sleep and being kept awake?

Can you imagine not being able to offer your visitors anything?

Can you imagine being very, very frightened and no-one understands that your fear is real?

Can you imagine being given pills to recover from a terrifying experience?

Can you imagine being shaped into something which is contrary to who you are?

Can you imagine being so completely on your own you feel dead?

Can you imagine then being told you will never get better?

• A number of case studies throughout this report illustrate the benefits

the Studio provides and consequent difference and impact on people’s lives.

Social Capital • People who suffer a breakdown invariably think they are alone so the experience of being able to regularly join a group of people with mental health problems creates a safe space in which to take tentative steps towards recovery.

A Poem from The Game - An Anthology by Sean McDermott

• Previous studies suggest that ‘sheltered’ environments are necessary

and fulfil an important role for vulnerable people. As in studies by Heenan (2006) and Perry et al 3 (2008), studio users identified NAGAS as an important ‘safe space’ for activities that was very important in their lives. Those studies also acknowledged how short-term projects can be detrimental to individuals’ wellbeing, especially those users who have experienced a loss. Outcomes such as confidence or reduced isolation are often temporary, disappearing when projects close.

• Research4 also suggests that community arts can create social capital -

“Aspects of social capital include trust, civic engagement, social relationships and social support.” This concept relates to social networks and the value obtained by participating in them.

• There was a sense of a strong element of peer support between members in the studio with users being protective of each other. Some came in pairs each week, others always attended on a certain day as they knew there would be familiar faces, instances were quoted of friendships that extended outside the studio. Others recounted their awareness of users who had suffered traumas abroad, and recognised the need to support these individuals despite their own problems.

• Literature on social capital literature suggests the arts have the potential to generate social capital that creates bonds between individuals. Putnam and Feldstein (2000)5 propose that the enjoyable aspect of artwork makes this the most promising, albeit neglected, way of developing social capital. They argue that that the

3 Heenen, D. (2006) Art as Therapy: an effective way of promoting positive mental health? Disability and Society. 21:2, 179-191.

4 Health Development Agency 2000

5 Putnam, R.D. and Feldstein, L. (2000) Better Together: Restoring the American Community.

participatory nature of art can develop many ‘civically valuable dispositions’ such as trust, openness, honesty, cooperativeness, tolerance, and respect, which in turn help to build and nurture social capital. In addition, actively participating in art creates enjoyment that can lead to a willingness to connect with others.

• This evaluation draws on the findings of a dissertation undertaken as

part of a Masters in Social Work at the University of Durham. The study explored the experiences of service users of two agencies, one being the Newcastle & Gateshead Art Studio, who regularly access creative activities. Semi structured interviews were conducted to determine what users view as the real benefit of their involvement in creative activities - the process, creative expression, the product, or none of these. The themes that emerged related specifically to wellbeing and social exclusion, with participants valuing both the creative experience and the opportunity to socialise.

• There was extensive overlap in the findings of the two reviews. The list

below shows user perceptions on what makes NAGAS an effective service, and the benefits and impact NAGAS has on people’s lives. Both exercises resulted in these findings, many of which were also endorsed by referring agencies in this evaluation report.

• The key aspects of NAGAS that are perceived as being intrinsic to how

the charity is able to reach and support people with mental health problems include: • a relaxed and informal studio atmosphere • a safe, sheltered environment • the semi structured nature of the service • human contact, especially for those who have difficulties forming friendships • a sense of achievement from meaningful activity • an awareness of increased skills and confidence • activity preventing relapse - a clear link between keeping busy and mental well being • a reluctance to access mainstream services due to feeling ‘different’

M lives in east Newcastle with her daughter and has a sibling in North Tyneside. She has been coming to the studio several days each week for two years after being referred from St Nicholas Hospital.

Despite a real fear of being around men, M feels supported by staff to the extent that she is able to sit and work at tables of mixed groups Although M does not feel confident enough socially to go to the shops, or attend other more structured settings (which she has tried), she feels safe in the studio and quotes the ‘huge difference’ it has made to both her and her daughter’s lives. M had no real friends until meeting other women at the studio who now meet up and check up on each other when not at studio sessions. Having had no previous experience of art she now makes detailed mosaics which give her the feeling of ‘doing something productive’. Prior to coming to the studio, M’s daughter did her college course from home as she felt responsible for her mother. Knowing that her mum is well supported in the studio has enabled her to attend lectures and her resulting grades have been merits and distinctions. To quote M, “Everybody is so helpful, nothing’s a problem, and they are there to help

in crisis situations too.”

A Project Perspective Monitoring • Analysis of previous project management and monitoring activity showed a robust organisation that took care to review its activity.

There was evidence of internal monitoring to determine whether NAGAS was specifically meeting the needs of users.

• When reviewing user outcomes, NAGAS used a wide range of tools to

assess whether studio services achieve intended outcomes.

Monitoring methods included: • art work produced • case studies • questionnaires • meetings held within the group • a database detailing the precise activities members have participated in • the use of external evaluators • quotes books • a partnership with a Day Activities Consortium Link Worker • stand alone projects to provide feedback  NAGAS produced a review of its activities and outputs between 2008-

2011 as a requirement of a three year well-being grant. The results below demonstrate the project’s operational capability, quality of services, and support that NAGAS provides for people with mental health problems:  268 new members benefited from access to 40+ separate art practices with professional artist support and materials available free of charge  9,000+ separate attendances over the 3-year period 2008-11  a successful proposal to manage the decommissioning of St Nicholas’ Art Room service by NTW Trust. This service was about to close immediately without any support for its long standing members.

NAGAS successfully managed the service for 18 months and then supported the subsequent transition of service users to the NAGAS community based studio.  the production of a book based on the life and times of the Art Room and its members. All members of that service given a copy of the book  continued support for the development of music sessions at the Sage, Gateshead  the development of the NAGAS user led Advisory Group and support for members  the delivery of a printmaking project in partnership with Northern Print  the delivery of two WEA courses in arts and crafts, and printmaking  the development of a creative writing course in conjunction with Launchpad  the involvement of 12 studio volunteers  working partnerships with many organisations in the fields of arts and health, including close working relationships with the other Art Studios in the North East  active participation in the network of Art Studio Managers in the region  involvement in eight local 8 exhibitions  annual participation in a variety of events for World Mental Health Day  The level of delivery that NAGAS is able to achieve reflects the calibre and professionalism of its staff in being able to respond to, manage, and successfully support a broad audience of people with wide ranging mental health issues.

“NAGAS encourages people to push themselves, to move out of their comfort zones” Referring Agency

Progression - Volunteering, Employment, & Education  Since 2006, NAGAS has: • supported 28 volunteers, six of whom were originally service users who progressed to a volunteering role in the studio. Two have since become paid sessional artists within the studio • helped two members to progress to study for a BA and one is studying

for an MA in textile design as a direct result of the support from NAGAS staff • managed a creative writing group that demonstrates progression

routes. One member now attends an Arts in Education writing class, and many members are keen to read in group settings in the studio, and also in public situations such as the art exhibitions organised by NAGAS in local venues

• designed and delivered 14 exhibitions • NAGAS has strong partnerships with external agencies – Moving

Forward, Tender Buttons (comunity theatre), Northern Print, Crisis Skylight, Westgate Community College - that mean members are supported to find the next step in the recovery.

Conclusions & Recommendations • The evaluation confirmed that NAGAS has developed an effective

model of semi structured support for a vulnerable and problematic client group, endorsed both by users and agencies working in the field of mental health.

• The Arts Council England published a review on The Arts and Social

Exclusion (Jermyn 2001) which listed a number of findings relating to the impact of the arts on social exclusion, including: • develops self-confidence and self-esteem • increases creativity and thinking skills • improves communication of ideas and information • improves understanding of different cultures • enhances social cohesion • The views and feedback from both users and representatives of

“What seems to make it work is that it’s community based, and lets people build and develop their own structure within a supportive environment with clear boundaries” Referring Agency

referring and external agencies show that the art studio successfully engages with people with mental health problems to achieve these outcomes.

• Agencies referred to NAGAS as a critical “stepping stone” for individuals

taking their first steps on the pathway to recovery. Both service users and external agency professionals highlighted the need for a semi structured environment as the first step for people with mental health problems starting their pathway to recovery. It was clear from everyone contacted that NAGAS provides precisely the type of flexible framework that offers an initial supportive environment for individuals who are not ready to join organised groups and classes.

Impact • Social Capital - users and agencies highlighted the social capital created

through friendship groups, regular groups of people with both mental health problems and a learning disability diagnosis, social networks that extend outside the studio. Whilst the benefits of being with ‘similar’ people were often mentioned by users, the studio has such a broad audience that people are naturally brought into contact with a people with very different experiences and backgrounds and often work together in groups on projects for exhibitions.

• Support -it is testament to the two staff at NAGAS that the studio can

accommodate such a diverse client group that presents with such a broad range of conditions and needs.

• Staff -bring a unique and valuable mix of skills and experience to the

Studio model. Both staff have backgrounds working in mental health, practical experience of supporting community based initiatives, and artists in their own right. It is this combination, and their flexible and supportive approach, that enables the Studio to respond to a wide range of needs, across the spectrum of mental health issues and learning disabilities.

“Pure quality comes out of the Studio” Referring Agency

Good Practice • There was clear evidence of good practice and examples of what the Studio delivered particularly well:  development work through outreach taster sessions to raise and build profile  the design and layout of the studio is such that it accommodates a wide range of conditions and abilities  highly qualified and experienced staff who bring a distinct

understanding and approach that is often quoted as the reason for NAGAS being the successful project it has become  work with individuals to meet individual needs  an accessible facility - the table design and spacious layout allow individual work and also encourage and support group interaction  project based work - stimulating group work and goal oriented projects that provide platforms for individuals to break through barriers and speak up for themselves  a useful resource - of books, the internet, music  individual studio space - to encourage personal interest in productive activity  an extraordinarily wide range of art forms - to stimulate interest and activity  one-to-one support from qualified artists with experience of mental health issues and/or experienced arts professionals Future Opportunities • NAGAS has been working for some time towards a portfolio of funding and income streams to support its operation longer-term and the charity’s strategy involves: • charitable grants • personalisation • charging policies • GP Commissioning • statutory funding streams • The introduction of personalised budgets is still some way ahead as a

commissioning system of payment by results is still being discussed and considered. NAGAS has good relationships with agencies involved in these developments to ensure it can be part of the discussions. Its reputation is widely recognised and acknowledged as a key support service for people needing help to take the first steps to recovery. It is well placed to position itself as a key service provider. The challenges will be the level at which personalised budgets are allocated - only those with substantial or critical levels of need are likely to be in receipt of personalised budgets whilst the majority of NAGAS users and referrals fall below that assessment threshold.

Future Development  Work is ongoing with ACEVO concerning support for the charity around leadership and development. ACEVO is supporting NAGAS to develop opportunities linked to the personalisation agenda and with further developing governance.

 MHNE has chosen NAGAS to benefit from an intern from Newcastle University business school to support future planning.  NAGAS is viewed as an exemplar model given its development work on the personalisation budget model. Discussions are underway with local authorities and the PCT given the charity has systems in place to pilot this new approach of supporting people with mental health problems.  The charity is looking at ways of involving more service users at board level, including training • In summary, the design, layout, and philosophy of the studio

create an appropriate and beneficial space and place for people starting out on the pathway to emotional well being and recovery.

Having previously lived abroad, and formerly always with family, R returned to the North East to a 1-bedroom flat in the east end of Newcastle. It was a lonely existence with no daily routine. For the first six months, R came to the studio and simply sat and read, or listened to music, and made tea. One day she was invited to join a group of users blowing paint on to canvas and found it was fun to mess around. This led to her starting to paint and she has since produced 100 paintings that show a love of colour and reflect people and personalities in her life.

Whereas previously she had no routine, R now comes every day to the studio, enjoys the company, and after months of sitting alone has made a good friend. She also feels she is more productive in the studio than at home. Now a volunteer in the Studio, and a member of the NAGAS user advisory group, R is now active in her community having featured in a Radio 4 programme about the east end of the city and is keen to set up a hobby room for tenants of the Byker Wall.

Appendix 1 - Contacts Jim Armstrong, OT, St Nicholas Hospital Ray Evans, Team Leader, Care UK Dave Hollywood, Support Worker, Summerhill Community Mental Health Resource Team Angela Houghton, Hostel Manager, Saint Vincent de Paul Trust Ian Pearce, Service Worker, Moving Forward, Mental Health Concern, (formerly Link Worker) Julia Perry, Manager, Moving Forward, Mental Health Concern, (formerly Clubhouse Manager) Derek Macchiocci, Team Leader, Moving Forward, Mental Health Concern (formerly Service Manager Tom Carpenter Centre) Tess Ward, OT Newcastle East Community Mental Health Team

Appendix 2 - Trustees Brendan Hill (Chairman) Chief Executive of Mental Health Concern (MHC). MHC is a registered charity that helps people with mental health problems to live valued lives, with or without symptoms of mental ill health. Based in the North East of England; providing a wide range of specialist mental health services commissioned by the NHS and Local Authorities.

Alisdair Cameron (Vice-Chair) Team Leader of LAUNCHPAD. Launchpad work to redress the balance, and offers the chance for anyone who uses mental health services in Newcastle to have their voice heard by the people who run these services.

Christine Lopez Voluntary Services Manager Northumberland, Tyne and Wear NHS Foundation Trust. Northumberland, Tyne and Wear NHS Foundation Trust is one of the largest mental health and disability Trusts in England providing services Northumberland, Newcastle, North Tyneside, Gateshead, South Tyneside, Sunderland and North Easington.

Douglas Hunter Director of Equal Arts. Equal Arts deliver projects to improve the quality of people’s lives by helping older people participate in high quality arts activity.

Reverend Jim Craig Rev Jim Craig, Community Arts Chaplain, Gateshead. Encourages people to engage with "The Arts" on their doorstep, and helps them to get creative themselves. Runs Sanctuary Art Space at St. Edmunds Church in Gateshead

Venita Kanwar Improvement Manager. Has had a wide range of experience in local government management

Jim Cousins Former Member of Parliament for Newcastle upon Tyne Central.

Appendix 3 - NAGAS Client Group

NAGAS membership covers the mental health needs outlined below: Severe and enduring mental health issues - Includes members with Schizophrenia, Bipolar, and extreme cases of common mental health problems Emotional Wellbeing - This group covers those with more common mental health issues such as Depression, Anxiety, Phobias, Substance misuse, Eating disorders, and Self harm Learning Disabilities Members - This group covers those with mild and severe learning issues and includes those with Autism High functioning Autism Spectrum - These members have been separated from those with low communication levels of autism Physically disabled members - those who use mobility equipment Personality Disorder - This group covers a range of individuals, please note not all have given this diagnosis but display clear symptoms Carers - Some members come in with carers, this membership only captures about half carers as some do not wish to become a member

Appendix 4 - Service User Survey SINCE COMING TO SESSIONS AT THE ART STUDIO......

Statements

None of the time

Rarely

Some of the time

Often

I’ve been feeling optimistic about the future

0

4

17 (1)

9

9 (6)

I’ve been feeling useful

1

3

14 (1)

12 (3)

9 (3)

I’ve been interested in other people

0

3

8

16 (3)

11 (4)

I’ve had energy to spare

4

9

16 (2)

6 (3)

4 (2)

I’ve been dealing with problems well

2

5

13

13 (4)

6 (3)

I’ve been thinking clearly

1

6

13 (2)

13 (2)

6 (2)

I’ve been feeling good about myself

4

2

13

10 (3)

12 (4)

I’ve been feeling close to other people

1

5

16 (1)

9 (1)

10 (5)

I’ve been feeling confident

3

2

13 (1)

13 (4)

11 (2)

I’ve been able to make up my own mind about things

2

2

10 (1)

13 (3)

10 (2)

I’ve been feeling loved

3

7

9 (1)

7 (1)

11 (5)

I’ve been interested in things

1

4

8

17 (3)

8 (4)

I’ve been feeling cheerful

1

5

13 (1)

10 (1)

11 (5)

I think the time I spend at the art studio makes a positive difference to how I feel

0

0

7 (1)

11 (2)

21 (3)

I think that coming to the studio makes me feel less likely to need medical or clinical support eg GP visits, CPN support, etc

1

7 (1)

8 (1)

19 (4)

I believe the support I get helps me cope better with my condition

0

7 (1)

12 (2)

20 (4)

5 (1)

0

All of the time

() the figures in brackets indicate people with both mental health problems and a learning disability

Newcastle & Gateshead

Art Studio

The Blackfriars Centre, Newbridge Street, Newcastle upon Tyne, NE1 2TQ Tel: 0191 261 6027 Email: bobmalpiedi@rocketmail.com

Kmeikle1@aol.com

Web: http://www.wix.com/bobnagas/nagas-1 Blog: http://nagasartcommunity.wordpress.com/ Company Reg: 5028177 Registered Charity No: 1116957