UP & AT EM PROJECT! – Charlton Athletic Community Trust

Charlton Athletic Community Trust & Oxleas NHS Foundation Trust devised and delivered a very successful 12-week pilot project. The project was for those aged 65+ with a mental health diagnosis. The pilot was designed to enhance participants’ physical health and wellbeing, through activities within the community, both locally and regionally. We are pleased to announce that after the evaluated pilot Oxleas confirmed 3 years of funding for the project taking delivery up until 2020. Year one is now halfway through delivery.


  • From start: No
  • During process: Yes
  • In evaluation: Yes


  • Peer: Yes
  • Academic: No
  • PP Collaborative: Yes

Find out more




What We Did

Charlton Athletic Community Trust & Oxleas NHS Foundation Trust devised and delivered a very successful 12-week pilot project. The project was for those aged 65+ with a mental health diagnosis.  The pilot was designed to enhance participants’ physical health and wellbeing, through activities within the community, both locally and regionally. We are pleased to announce that after the evaluated pilot Oxleas confirmed 3 years of funding for the project taking delivery up until 2020. Year one is now halfway through delivery.

The schedule of activities offer a full and varied range including sporting, leisure, art and cultural based activities, and is adapted as necessary to be age appropriate. The programme is managed, scheduled and delivered by 2 members of the CACT team with support from a designated member of staff from Oxleas. Transport for the activities is also provided by CACT.

The project is delivered by non-clinical staff in non-clinical settings. The programme provides a sense of ‘normality’ during a time of crisis in both health and identity caused by a diagnosis of mental illness. The project supports the relationship between participants and the secondary care services.

The informal delivery style provides an arena for participants to socially interact and share experiences with others who were in a similar position to them. These social bonds between participants are important as often during ill mental health informal support and peer groups fall away and people can become isolated. The group engagement and dynamics were also designed to improve connection with communities and to help people feel less lonely and isolated. Participants report that the variety of activities are a platform and backdrop to a deeper level of support that the project provides which increases the more they engage with the project and other participants.

Having said the above the activities are very important and provide opportunities for people to engage in activities they may never have done or have not experienced for a long period of time due to varying reasons including ill mental health. Examples of this are below

Barbara held a tennis racquet for the first time in 40 years and was clearly a natural.

The last time Dennis (87) visited the cinema he was in his 40s

Maria (79) played indoor Bowls for the first time ever on the project and attends a weekly session at her local leisure centre

Roy (70) worked for 30 years travelling up and down the Thames carrying refuge out the city. On the project he relived the journey for the first time in 25 years on a Thames Clipper and was glued to the sights all the way and the changes to the views of the capital from the river

Ken (76) had never visited the theatre until the project offered an opportunity to visit the Adelphi Theatre in London to watch Kinky Boots. He reported loving the experience and feeling uplifted by the atmosphere the theatre provided.

Further examples and stats are provided in the evaluation section


Wider Active Support

Oxleas NHS Foundation Trust and Charlton Athletic Community Trust (CACT) have been working closely over the last 4 years to deliver bespoke packages of intervention to service users under the Oxleas Early Intervention in Psychosis teams and Older People’s Community Mental Health Teams.CACT also deliver additional programmes in forensic and secure units within Oxleas.

The UP & AT EM project positively supports co-working collaboration between secondary health care services and voluntary sector.

Oxleas recognise the value of an organisation such as CACT and commission CACT to plan, manage and deliver the project. CACT’s are skilled at ensuring a non-pressured platform that encourages clients to engage but only at their own pace. It is supported from one band 3 support worker employed by the Oxleas NHS Foundation Trust Older People’s Mental Health Directorate. Transport for the activities was also provided by CACT

Regular meetings are held between CACT and Oxleas to ensure smooth delivery on the project. The relationship is strong and both organisations are driven to ensure a client focused and supportive provision.

CACT use many of the partners to help deliver the activities or use their facilites as venues for the project. The strong relationships CACT holds with the community ensures this is always cost effective and always in community settings which is essential for the success of the project.



At the start of every 10 week block we hold a welcome session for all clients and their carers. Previous evaluation has told us that people find engaging in the first week of activity a difficult barrier to overcome. Running a welcome session takes the pressure off clients and allows them to listen and engage at their own pace. We find that the majority of clients will engage with others at some stage of this more relaxed session allowing for a more confident approach to the first programme activity. Carers have also fedback that them understanding the project better themselves has encouraged them to support clients to attend more.

Feedback is recorded from all clients on every activity with the information used to help shape and design the next blocks of activity. Staff from CACT and Oxleas evaluate each block of activities from a staff perspective and implement any changes they agree will improve the service and enable it to evolve.


Looking Back/Challenges Faced

Transport has been a challenge on the project. CACT provides transport from a central meeting point to all activities. This has worked well and encouraged participants to use public transport to get to the meeting points. There have been occasions when the day is longer such as a Theatre Trip where it has meant an earlier start and later finish for clients. This has affected their ability to attend at times. Now we recognise the need of extra support on those days and CACT staff do pick ups and drop offs from the home addresses of the clients. This negated the attendance problem immediately.

One other challenge for the programme which has surfaced is managing the expectations of clients as their block of 10 weeks finishes. Clients have reported feeling disappointment when the programme finishes for them as with each 10 week block the project moves on to another set of clients. Both Oxleas and CACT staff work hard with attendees to also prepare them for the end of the project. We work with the clients to set targets for staying engaged with other attendees and community venues and have scheduled additional catch up sessions beyond the project block.


So strong has the success been of the UP & AT EM project that Oxleas have confirmed funding for CACT to continue delivery of the project at least until 2020. This commitment from Oxleas is amazing and allows CACT to secure key staff who will deliver long term on the project ensuring the consistency and quality is there. The project has always been and continues to be delivered by the Head Of Early Help & Prevention (12 years at CACT) and the Disability & Mental Health officer (9 years CACT). Both are established members of staff with many years of delivering projects across the mental health services. CACT have a layered structure in place to manage effectively and quickly any changes in staff although none in this department are expected.

Evaluation and further evidencing the project’s value will develop over the next year. With funding confirmed to 2020 this will give us a healthy run it to ensure funding is committed beyond that point. CACT recognises that key to sustainability is ensuring wider recognition in the form of awards such as these.


Evaluation (Peer or Academic)

Oxleas NHS Foundation Older people’s mental health staff ran an evaluation of the pilot project and continue to evaluate the main project. Below are the main statistics from the pilot and also some findings on how the project provided a long term saving for the mental health services.

• 16 Participants
• 12 Weeks of activity involving 18 different activities
• 95% Minimum attendance each week
• 50% of participants continued to meet independently beyond the
• 90% reported an improvement in mood
• 100% said they would attend a repeat project

Oxleas NHS Foundation Trust agreed for one band 3 support worker to be released to support the project. She provided 5 hours per week for the 12 week period (60 hours) at the cost of £820.20 plus additional time for ensuring pre- and post- measures were completed.

The support worker liaised regularly with care co-ordinators and this meant that, unless there was a change in presentation, care co-ordinators did not need to provide as much intervention as previously. They were aware that service users were involved in the project and still receiving support from mental health services. Feedback from care co-ordinators who had service users attending the project was that their contact with them “significantly reduced” during the timeframe of the group and led to a number of service users being discharged completely from secondary mental health.

For the average attendee, prior to the group they were being seen fortnightly for an hour by the care co-ordinator at a cost of £135.12. During the period of the group, care co-ordinators were tending to see service users once a month, for a short period of time (approximately 30minutes) reducing the cost to £33.78.


Two outcome measures were used as part of the pilot project – Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and Core 10. WEMWBS is a measure of mental wellbeing and looks at how people are interacting with others, their confidence and self-esteem. Core 10 is a generic measure of distress and helps to measure anxiety, depression, risk and functioning.

66% of group members demonstrated improvement on the mental wellbeing rating scale. Three people showed a decline on the WEMWBS. These three service users were the most unwell of the group so their presentation may have affected the results.

CORE 10:
Over half showed an improvement on the Core 10 scale. For some people there was quite a dramatic reduction in feelings of distress as a result of attending the group. For those who had an increase, this was generally by a small percentage and could be due to increased awareness of symptoms as a result of attending a group with other service users with mental health conditions.

We also gathered qualitative feedback:
• “The different experiences have been amazing”
• “Every minute has been lovely – I never expected it to be so good”
• “I have been here for the last 12 weeks and thoroughly enjoyed the activities”
• “Now I can look back on my younger days”
• “The company has been great”
• “Very uplifting is all I can say”
• “I appreciate all the care and support shown to me”
• “Thanks for all the hard work put into the groups. They were varied, interesting and fun”
• “Thank you for Up & At ‘Em. I appreciated every minute”


Our work with Oxleas and the UP & AT EM project is always promoted by CACT and CAFC through website stories and social media. Oxleas also promote the project heavily through their channels.

CACT also hold a place on the board of Governors at Oxleas and have presented the project to all governors including visiting governors from other NHS trusts

CACT’s community programme is highly regarded with the trust receiving the English Football League “Community club of the year award” in 2016. Our work programme is widely recognised as one of the country’s leading community trust programmes and other trusts are always keen to learn from the work CACT has developed. Our mental health work is no different and is well respected and valued by partners, with whom we regularly share our best practise. This is highlighted by long term relationships and financial commitment with with Oxleas (7 yrs) & Kent and Medway NHS Trust (10 years)


Is there any other information you would like to add?

Charlton Athletic Community Trust (CACT) have been delivering mental health projects for over 12 years. The Oxleas UP & AT EM project which we are putting forward for this award is our latest addition to which is now a comprehensive programme of delivery across our regional mental health services. We are very passionate about how we can support individuals and the mental health services. Below is a brief history of our mental health work which we feel shows our ongoing commitment and long term partnerships.

Our main project over recent years which is still ongoing is our activity recovery and inclusion programme for participants who are receiving a service from the Kent and Medway NHS Trust’s Early Intervention in Psychosis teams. This project is now into its 10th consecutive year.

Due to the success of the Kent provision CACT was approached by Oxleas NHS Foundation Trust in 2012 to deliver an identical programme to their own Early Intervention in Psychosis teams in the London Boroughs of Royal Greenwich, Bexley and Bromley. This project is now into its 4th consecutive year of delivery.

CACT have delivered in secure and forensic settings within both Kent and Medway Partnership Trust (KMPT) and Oxleas. Further to that we have delivered in partnership with community mental health teams adjusting and adapting the projects in line with the resources and needs of each team.

In 2014 the Oxleas project received the Partnership Project of the Year Award and in 2015 CACT’s mental health projects were presented with a ‘Recognition of Excellence’ award by the Institute of Integrated Care.

The Oxleas EI project was nominated by the participants for the BBC ‘In the Mind’ award in January 2016 and in March 2016 CACT presented the programme as an example of best practice at the Early Intervention in Psychosis Network annual national conference focusing on Achieving Better Access.

All projects continue to be very successful and very well attended. Existing delivery has a very equal gender split evidencing how the varied style of delivery appeals to all.

Mental health teams involved with our delivery consistently view the projects as an integral components of the recovery plans of the people they work with; County Manager of Mental Health Primary Care Social Work Services Yasmin Ishaq stated that “most attendees will find something in the activity programmes that they want to do and the process of participation with others not only helps improve emotional wellbeing but also helps create networks and new friendships”.

CACT are very proud of our history of effective delivery and long terms partnerships built up over many years.


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