Everton in the Community (EitC) were the first Premier League football community scheme to address mental health as a targeted programme. The first and largest of our such programmes is the FA charter standard mental health football project, ‘Imagine Your Goals’ (IYG). IYG uses the power of football as a positive vehicle to address mental illness.
Co-Production
From start: Yes
During process: Yes
In evaluation: No
Evaluation
Peer: Yes
Academic: No
PP Collaborative: Yes
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Johnnie Garside - Mental Health Football Coordinator
Everton in the Community (EitC) were the first Premier League football community scheme to address mental health as a targeted programme. The first and largest of our such programmes is the FA charter standard mental health football project, ‘Imagine Your Goals’ (IYG). IYG uses the power of football as a positive vehicle to address mental illness via targeting the following objectives:
1.) Increasing Participation: • We deliver 7 regional football training sessions, engaging 200+ service users per week. • This is the only/ main sporting activity for 77% of participants.
2.) Enhancing health and wellbeing: • 58% of IYG participants reported they were able to reduce their use of medication or mental health services since starting IYG, (86% direct attribution rate to IYG). • 64% of participants reported that they have lost weight since joining the programme, (81% direct attribution rate to IYG).
3.) Providing volunteer and employment pathways: IYG has supported 55 service users into active volunteer opportunities contributing 1,415 volunteer hours. 56% of these would not have volunteered if they had not participated in IYG. IYG volunteer time leverage’s a greater value per £1 spent than it could get additionally in gift aid per £1.
A Social Return on Investment (SROI) analysis demonstrated that IYG have supported 24 participants into employment, helping to generate a social return value of £455,856 in calculated cost savings. Based on all the programme objectives IYG has an overall SROI value of £3.22 for every £1 invested. This figure demonstrates the significant benefit the programme delivers to its participants/ local council services and national exchequer contributions with direct and indirect cost savings (Social Return On Investment, August 2013).
4.) Creating Training and Education opportunities: • Over 280 service-users have completed FA coaching and gym instructor qualifications. • IYG has provided health training/ workshops and counselling courses to 199 service- users and support staff.
5.) Providing Competitive football opportunities: IYG organises the largest Mental Health football league, involving 16 community mental health teams, engaging over 200 service users per month.
IYG are regional, national and international football champions after winning the European Mental Health Championship in Hamburg Germany http://www.lewesfc.com/champions/
6.) Raising Awareness of mental health and challenging stigma: IYG host the UK National Mental Health Football Championship each year that coincides with World Mental Health Day (the largest tournament of its kind in the UK). It engages teams of mental health service users as well as teams from the public and private sectors. The tournament helps to raise awareness of mental health and is intended to help the public better understand mental illness. http://www.baytvliverpool.com/article/detail/162
Working in partnership with FACT Liverpool (http://www.fact.co.uk/) IYG have merged together art, sport and mental health via an innovative creative arts project centring on the themes of mental health, erectile dysfunction, masculinity and what it means to be a ‘real man’.
http://www.artsadmin.co.uk/projects/mark-storor-the-barometer-of-my-heart IYG actively promote mental health awareness and support the ‘Time-to-Change’ campaign, signing an organisational pledge to stamp out mental health discrimination.
http://www.evertonfc.com/news/2011/10/10/hahnemann-helps-out To date we have trained over 1000 members of the public, staff, volunteers and peer mentors in Mental Health awareness and MH first aid training.. IYG host exhibition matches coinciding with Everton home fixtures, where 1st manager Roberto Martinez helps raise awareness of mental health, engage with fans, celebrate participants progress, and supports marketing materials in match programmes/ stadium screens: http://community.evertonfc.com/news/martinez-helps-celebrate-world-mental- health-day/
7.) Underpin project impact with academic research
Wider Active Support
Everton in the Community’s pioneering provision to tackle social and economic challenges facing Merseyside would not be possible without reliable cross-sector partnerships. Our long-standing collaboration with Mersey Care NHS Trust was the first cross-sector partnership to deliver a non-traditional health pathway as a distinct alternative to conventional medical recovery models NHS Trusts delivered. This partnership is now underpinned by academic rigour embedded into delivery by Edge Hill University.
Mersey Care NHS Trust: funders of the 5 community outreach programmes and providers of specialist mental health support and services in North West England.
The future for the partnership has been strengthened significantly following the introduction of Edge Hill University (Times Higher Education ‘University of the Year’ 2014) to provide independent monitoring and evaluation of our work, and broaden its impact (https://www.edgehill.ac.uk/news/story/edge-hill-partnership-everton-community/).
In association with EitC, the University is launching a new MSc Sport, Physical Activity and Mental Health programme in September 2015, which will be the first of its kind and will provide accredited CPD training modules and annual dissemination and sharing best practice workshops/conferences based on work undertaken with EitC.
In addition, a dedicated Centre for Sport, Physical Activity and Mental Health Research is planned to undertake and facilitate the production of high quality, publically engaged and policy relevant research which advances international understanding of the links between sport, physical activity and mental health. The Centre brings together academics, practitioners, policy makers, representatives of sports bodies, service users, those with mental illness, and the public, private and voluntary sectors to inform policy and practice to enhance the mental health and wellbeing of individuals and their communities.
Mental Health Football UK: https://www.liverpoolfa.com/news/2015/mar/mental-health- football-uk We have supported one of our service users to founder and establish a national charity that aims to share best practice and increase footballing opportunities within the mental health sector.
Co-Production
As part of our monitoring and evaluation framework our steering group meetings are attended by all relevant stakeholders, peer mentors and service user representatives. As part of their role feedback is gathered to review areas for improvement to undertake further strategic planning and to ensure grants are providing value for money.
As part of our employment strand we have employed three service users from the programme to take up part- time ‘peer support worker’ and coaching roles at the club. These roles provide vital support to both staff and service user as well as promoting recovery amongst existing service users on the programme. They have invaluable personal experience and levels empathy in relation to understanding the needs of service users and being best placed to help support them on our mentoring and leadership ‘buddy- buddy’ programme. This process takes the form of informal social prescription covering areas such as work, education, leisure and financial management as well as choosing positive lifestyles choices and early intervention observations. They also work within the in- patient areas across the service, promoting the programmes as well as feeding the information directly into our steering group meetings.
Looking Back/Challenges Faced
In hindsight we would place greater emphasis on conducting more regular consultation opportunities for service users, staff, stakeholders and researchers. To anonymously input their thoughts, comments and ideas on project delivery, quality and ultimately the evolution of the programme as it attempts to be proactive instead of reactive to changing needs and sector trends.
We also feel greater partnership work would benefit the programme greater in regards to providing tangible exit and progression employment routes. We have traditional been very effective in providing training, education and volunteer opportunities within our organisation. However, we feel a greater emphasis on a broader network of partners would have helped cater for differing needs and interests.
Prior to implementing the project a wide consultation with mental health service-users identified a number of barriers preventing them from accessing social opportunities in the community. Extensive academic research had however highlighted the benefits of social contact for those experiencing mental health problems, particularly emphasising the value of sport and physical activity in helping individuals deal with their symptoms. What became clear was that people had the desire to attend our sessions but often faced multiple challenges, such as anxiety, a lack of human support, negative effects of medication and poor access to transport.
As a result of this consultation a number of specific methods were implemented to engage the widest possible participant base, from hosting our football sessions later in the day to counteract the negative effects of medication, to restructuring session formats to offer both professional coaching and competitive football. A significant breakthrough came when our NHS partners provided 35 support staff throughout the region with contracted hours in their week to bring participants along to the sessions as part of individualised support packages.
On the back of the huge success the programme has achieved during the first five years of its tenure new challenges have been identified as we have grown in both number and age of participants, as well as level of influence we have with them.
Three such challenges:- include service users who fall into the over 40 years of age category and wanted to have their own group where the ability level was more evenly balanced and they could participate in different sports; The second challenge was that of employability and progression routes back into employment; And finally, how we could diversify our range of provision to include mental illnesses such as dementia.
Upon identifying these challenges we designed specific programmes to help tackle this areas and approached our main partners Mersey Care NHS Trust to present pilot project proposals. The pilot projects were a great success in meeting the needs of the service users within these identified areas. Mersey Care NHS Trust have now commissioned a full roll out of these ‘Imagine Your Goals’ extension programmes centering on service users over the age of 40 called ‘Healthy Blues’, a mental health specific employability programme and a Dementia reminiscence programme called ‘Pass on The Memories’.
Sustainability
Due to the project offering a unique intervention to a problem that will affect one in four of the population, Everton in the Community is working extensively with a new national panel of multi-sector stakeholders, including the Department of Health, to explore how this best practice model can be implemented elsewhere.
The future for the partnership looks as bright as its glorious past as a recent announcement saw Mersey Care NHS Trust pledge over £200,000 in refunding to all the collaboratively-ran projects. Both Mersey Care NHS Trust and Everton in the Community officials meet on a regular basis to discuss all collaboratively-run projects, how they are being run, the wellbeing of staff and participants as well as media avenues they have available at their disposal in order to best promote the initiatives. Our funding partners, Mersey Care NHS Trust, have reinvested in the scheme for another two years (2016-2018).
Evaluation
*An independent report in the Journal of Mental Health Practice found that: 100% of participants stated they were fitter as a result of the programme; 94% had an improved sense of wellbeing; 59% had fewer mental health symptoms; 88% had more self-esteem; 76% were mixing more with family and friends; 76% had more hope for the future
In 2010 ‘Imagine Your Goals’ received a national roll-out, with 15 Premier League clubs adopting the programme nationwide. This legacy strategy still continues today with 6000 participants benefiting from the scheme to date. IYG has received several prestigious awards: 2010 Sports Industry Award for ‘Best Community Programme’; 2010 North West Football Award for ‘Best Community Project of the Year’; 2010 Tony Adams Award for ‘Positive Mental Health’; 2013 Partnership Working Award at the Breakthrough Positive Practice Awards in Mental Health; 2014 NHS Excellence in Supply Award; Mental Health Care & Overall Winners 2014 Charity Times Awards; ‘Cross Sector Partnership of the Year’ 2015 PFA Coaching4Hope: Best Community project shortlist.
Sharing
So often seen as a model of best practice amongst our counterparts, EitC and Mersey Care NHS Trust pride ourselves on sharing our ground-breaking approaches to harnessing the known therapeutic benefits of physical activity and sport on mental wellbeing.
EitC’s IYG programme are official members of: - The European Association of Social Integration (EASI); The European Football Development Network (EFDN); European Health Stadia Network; The Sport and Recreation Alliance: Mental Health charter; MIND ‘Get Set Go’ National Advisory Group.
The innovative approaches used within IYG have been shared on numerous best practice academic and practitioner platforms, including;
EFDN European Conference: http://www.farenet.org/news/club-foundations-and-social- responsibility-delegates-meet-in-manchester/
European Sports Development Network: https://www.edgehill.ac.uk/sport/esdn- presentations-2013/
National Mental Health Conference: https://www.youtube.com/watch?v=IUBge5yiwAk ‘Most Active County’ Stakeholder event: http://www.mostactivecounty.com/downloads/
National Substance conference: http://www.substance.net/news/the-substance-national-conference-sport-for-development- a-whole-new-ball-game/
Fit4Health conference, Langtree Park, 2015 http://www.healthystadia.eu/itemlist/category/ 143-fit-4-health.html
Through our connections with Mental Health Football UK we share significant information and best practice via their sizeable database and communication platforms.
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Case study:My story. My story is indeed extraordinary, it is also just one of many. After being sectioned under the mental health act in 2007, I was at the lowest point of my life. Apart from dealing with the stigma I put on myself, I also suffered with what I perceived would be stigma from my local community, people I knew, friends and family. As a result, I became agoraphobic; I didn’t leave my home to step outside for two months. Looking back it was because I was scared I might bump into someone who knew me and would ask questions.
Being a prisoner in your own mind is the most dreadful situation you could ever be in, when you are unable to go outside and do the things we all take for granted like breathing fresh air or to have the sun shine on your face. I was deteriorating in both mind and body. Though helping with the worst of my psychotic symptoms, the anti-psychotic medication I had been prescribed drastically increased my appetite. This, coupled with the fact that I was perennially drowsy and bereft of any sort of physical activity, resulted in my weight increasing dramatically by about three stone in two months. As my weight increased, so my self-esteem plummeted. I hated looking at my reflection in the mirror. Feelings of worthlessness set in. I had lost my self-respect, evidenced by the fact that I couldn’t even bring myself to get washed for a period of time. What was the point? I’d sleep from 10pm till 2pm, and every time I woke up during that time, I wish I hadn’t.
I felt trapped and began to think of a way out. At this time, I started thinking what would be the most ‘effective’ way offending my life. My CPN was detailed to pay me a visit once a week, though I had no intention of telling her how desperate I’d become. I used to hate these visits but it was something I was obliged to do. It probably saved my life, because that’s how I heard about mental health football sessions ran by Everton in the Community. My local was a ten minute walk from where I lived, but it may as well have been a thousand miles away. I agreed to go, because I’ve always loved football, on the agreement that she would drop me off and pick me up, which she did. I scored three goals that day, worked up a sweat, got to know a couple of people, and they got to know me. They’d been through their own problems and that helped me not to feel like an ‘alien’.
The next week, I decided to walk there, through the park to get there, though not on the paths, rather cutting across the fields. At that time, it was the only thing I had to look forward to, but it was something. My confidence slowly grew, I became more sociable, began to smile, lose my inhibitions. I didn’t feel ashamed anymore. I had got my freedom back.
My excess weight soon dropped off. My medication was reduced. I was sleeping better, I had something to look forward to, to get out of bed for, something worthwhile. At one point, I was attending a football session every day of the week.But playing football doesn’t earn a wage (though I wish I was that good!) and so I started volunteering with Everton in the Community with the delivery of the sessions and with Early Interventions team providing peer support for all the new patients coming in.
At this time I was diagnosed with cancer, and had to undergo surgery followed by chemotherapy. It was much easier for me going through that than it was overcoming my mental health issues. (It’s funny, whenever I tell someone that they always say ‘Are you O.K. now, has the cancer gone? They never ask if you’re mental health problems are over).
When I was better, I continued my volunteering and applied for a work experience placement within Everton in the Community and Mersey Care NHS Trust which allowed me to get paid for what I was doing, which felt great. Having confidence to play football and make new friends is one thing but having the confidence to do a job and sit in an office full of people is another when you’ve been away for so long.
As before, it was the feeling of wanting to get back playing football which saw me through! And if it hadn’t had something to do with football I might not have wanted to come back. I’d
even asked the surgeon if he could delay my operation by three days so I could play in a football tournament!
Currently, I’m still working for Everton in the Community and Mersey Care and I’ am awaiting starting John Moores University this September having just learned last week that I’d been accepted to study mental health nursing. I was in Uni many years ago. But in the last two years, I’ve picked up more qualifications through Everton in the Community than at any time in my life. This programme ‘Imagine Your Goals’ invests in people, both time and money and has, inadvertently, saved my life and gave it meaning. I have been free from anti-psychotic medication for three years.
My story is indeed extraordinary. It is also just one of many.