DOUGLAS BENNETT PRIZE
Description, rationale and evaluation of innovative service for people
with severe mental illness;
THE LAD (LIMAVADY ADRENALINE DUDES) PROJECT.
Dr Ronan Kehoe, ST4, Limavady Recovery Team
Address: Roe Valley Hospital, Limavady, Co. Derry, Northern Ireland
Telephone: 07763331403
Douglas Bennett Submission, 2013
Dr Ronan Kehoe, ST4 Psychiatry Trainee
THE LAD (LIMAVADY ADRENALINE DUDES) PROJECT. UNOFFICIALLY SPONSORED BY NESTLE
YORKIE BAR: IT’S NOT FOR GIRLS!
Dr Ronan Kehoe, Limavady Recovery Team
Description
According to the Strategic Framework for Mental Health “Much psychological and
emotional distress can be resolved by the imaginative use of generic services.” (National
Framework for mental health and well-being, 2012).
With this in mind, in August 2012 after a huge effort we applied to CLEAR (An Integrated
Community Development Project providing mental health & emotional well-being services in the
west of Northern Ireland) and were awarded £3800 to embark on our current innovative,
creative and ground-breaking LAD (Limavady Adrenaline Dudes) project.
Our programme targeted a population of our Recovery patients known to be less likely to engage
with mental health services (Killaspy and Halloway, 2009): young (18-30yrs), male, severe and
enduring mental illness. Rather than delivering traditional methods of mental health care that are
nationally known by evidence to be unsuccessful, we decided to implement a novel and fresh, nontraditional approach to promote positive mental health.
We therefore imaginatively tailored a service, specific to the individual needs of this clientele, and
adopted a non-traditional delivery of positive mental health by constructing and completing a 14
week activity programme of high intensity, adrenaline arousing activities including zorbing, hovercrafting and paintballing. However remaining at the core of the project was the traditional recovery
ethos: promoting a positive journey through social inclusion; building a life of hope, opportunity,
personal control and partnership beyond mental health. With the resultant shift of focus on
improvement in function, rather than symptoms. (Killaspy and Halloway, 2009). This ultimate
design was in keeping with the new government proposal for patient involvement and choice: “no
decision about me, without me!” (Government proposal of patient involvement and choice, 2012).
The Recovery team staff supported the construction, delivery and development of this weekly
programme and consideration was given to breaking the barriers of current social stigma: staff
attending in own clothes and participating in activities which out of personal comfort zones; the use
of private bus hire, not hospital transport; and, promoting patient preference and choice, selecting
activities that would generally appeal to the young, males in the community.
Douglas Bennett Submission, 2013
Dr Ronan Kehoe, ST4 Psychiatry Trainee
Rationale:
The rationale of the project was through our primary aim: to recognise, revise and reinforce generic
qualities that promote positive mental health through a recovery ethos on a background provision of
holistic care: communication, team work, problem solving, confidence building, social inclusion,
patience, distraction, daytime routine and structure whilst highlighting the universality of mental
illness. The ultimate goal would be the promotion of autonomy, independence and ownership;
creating preferences and choice through positive partnerships.
We aimed to improving users’ experience of care by provision of a community-based service for a
vulnerable community cohort by: Meeting the specific needs of the individual participants (by nontraditional delivery); Promotion of positive mental health and the universality of mental illness;
Increasing social inclusion; Psycho-education and reduction of stigma; Promotion physical activity to:
improve mental health; for natural release of endorphins; as a distraction from negative acts/
thought; and, for general physical health awareness; Access to an intensive intervention with trained
healthcare staff: training of more positive and natural coping mechanisms; creation of an
individualised mental health first aid box/ crisis plan; increasing awareness and forming links with
local groups; Encouraging carers support and involvement: through user involvement and captured
in carer’s assessments. This positively impacts on attendance and participation and crisis plans and
first aid boxes are encouraged to be shared.
Evaluation:
Quantitiative
We collected and employed a variety of measurement tools. Quantitatively we used MoHost,
(Parkinson, Forsyth and Kielhofner, 2006) a validated tool to assess global occupation participation.
This tool measures motivation for occupation, pattern for occupation, communication and
interaction skills, process skills and motor skills. Baseline and weekly scores were taken both
subjectively and objectively. Through retrospective analysis they showed a significant improvement
in global occupational function through all domains (table 1 and graph 1).
Further statistical analysis would indicate that the mode before intervention was grade A, Allows
Occupation, but this had improved to grade F, Facilitates Occupation, post-intervention. Similarly the
median pre-intervention was A, Allows Occupation, and this had improved to F, Facilitates
Occupation, post-intervention.
Advanced statistical analysis using paired t tests show that the changes in the grades from the
intervention are statistically significant, i.e. due to the intervention, rather than due to chance.
(Table 2)
Douglas Bennett Submission, 2013
Dr Ronan Kehoe, ST4 Psychiatry Trainee
Table 1 showing MoHOST scores before and after intervention
MoHost Scale
BEFORE INTERVENTION
Global Score (%)
AFTER INTERVENTION
Global Score (%)
F
Facilitates Occupation
39
56
A
Allows Occupation
40
34
I
Inhibits Occupation
19
10
R
Resists Occupation
2
0
Graph 1 showing MoHOST scores before and after intervention
60
% Score
50
40
30
After
20
Before
10
0
Facilitates
Allows
Restricts
Inhibits
MoHOST Scale
Table 2 showing paired t tests of MoHOST grade improvement from the intervention
Paired Differences
95% Confidence
Interval of the
Difference
Mean
-4.250
Std.
Deviation
4.528
Std.
Error
Mean
1.601
Lower
-8.035
Upper
-.465
t
-2.655
7
Sig. (2tailed)
.033
1.043
7
.332
3.763
3.067
7
.018
1.394
1.323
7
.227
Pair 1
F:Before
– F:After
Pair 2
A:Before
– A:After
1.625
4.406
1.558
-2.058
5.308
Pair 3
I:Before
– I:After
2.125
1.959
.693
.487
Pair 4
R:Before
– R:After
.500
1.069
.378
-.394
Douglas Bennett Submission, 2013
Dr Ronan Kehoe, ST4 Psychiatry Trainee
df
Qualitative:
These results are mirrored in qualitative data of: users, who personally attribute their positive
outcomes in terms of friendships, communication, social skills, interaction and habituation (“it’s
helped me make friends and realise I’m not the only one dealing with this stuff,” and “It takes you
out of your head for a while.”); and, staff, who support the improvement in similar areas of mental
health, social functioning, medication compliance as well as physical health and monitoring
awareness.
Personal Outcomes:
Through this experience, I am proud to affirm my role as a team member but also as a manager and
a leader: being able to conceptualise a deficiency within the current service provision and creatively
designing a project around it. It has given me the opportunity to manage not only a team of
professionals but also external providers, patients and a budget! Team work was a core factor of this
project: working within a capable and eager team was a foundation factor for success and the
resultant hugely positive impact on these relationships and the identification and development of
personal qualities were unremarkable. But for me, assessing and treating individuals, outside of my
comfort zone of a clinic room, in an unusual environment that at times involved frightening activities
that challenged my own personal boundaries was perhaps one of the most rewarding outcomes. But
ensuring the delivery of the project with roots firmly seated in a recovery ethos and with the
ultimate human outcome of viewing our users as individuals and not patients will be a memory that
will inspire and define my clinical practice for the fortunate length of my career.
Additional outcomes:
Other positive measurements of the project include: being cost-effective, four hour contact with two
MDT staff, weekly for 14 weeks; the increase in compliance with medication preventing drug
wastage; decrease in the use of drugs and the wider social financial impact of drink/ drug misuse; all
users have had reduction in key-worker input and none have entered into “crisis” therefore no need
for further crisis service involvement or multi-agencies and indeed NO hospitalisations. But
strikingly, can a financial cost be placed on positive mental health?
Furthermore our project is designed as a catalyst, to move patients through their recovery journey
and the Bates traffic lights model (Bates et al 2006) of social inclusion. Encouraging onward
involvement with e.g. leisure centre leads to maintenance of users’ positive mental and physical
health through their recovery journey (pacing, social inclusion, journey)
The Public Health Agency (PHA), Northern Ireland have also recognised the hugely positive outcomes
of our project and have kindly invested a substantial amount of money in March 2013 to continue
this project in our own area and to look at its expansion within our Trust and hopefully regionally!
Douglas Bennett Submission, 2013
Dr Ronan Kehoe, ST4 Psychiatry Trainee
Conclusion:
Knowing that a huge target group, young men with SMI, are known to be difficult to engage with
resultant mental health disability, we have adopted a non-traditional delivery of the traditional
message of positive mental health within the recovery ethos. We have run this project for 14 weeks
and have already seen significant results: quantitative analysis of occupational function shows global
improvement, qualitative analysis of both user and staff data show an even more significant
improvement in the physical and mental health of the users. The ability to initiate and maintain
engagement with this group of users is extremely commendable but to proudly say that we can
improve medication compliance, reduce stigma, provide psycho-education, promote positive mental
health and ultimately social inclusion, using the recovery ethos as its foundation is indeed, in
keeping with the Northern Ireland PHA 2013 agenda of “Delivering Excellence, Supporting Recovery.”
Douglas Bennett Submission, 2013
Dr Ronan Kehoe, ST4 Psychiatry Trainee