Investing in resilience

Resilience is the ability to rebound quickly from problems.

Robustness, elasticity, flexibility - the word, with the usual meaning, has plenty of synonyms. It is also a crucial part of improving our population's mental health.

Personal resilience means the ability to stay well during tough times in our lives when otherwise our mental health could be adversely affected.

However, while its value might seem obvious, for those working to build resilience there is a need to get beyond the common definition of the word and pin down its meaning more specifically, and also to try and find ways to measure it. Without that, how can we say it has improved (or the opposite)?

As a science, there is work to do, but progress is being made.

In 2011 the Young Foundation, alongside the London School of Economics, various agencies within government and other partners, produced WARM (Wellbeing and Resilience Measure) which sought to find ways to weigh both wellbeing and resilience at a community level (and which contains interesting observations on why these concepts are related but very much not the same).

Public Health England has tried to estimate the value of certain social programmes, and found that for every £1 spent on workplace wellbeing programmes saved £2.37 - while for every £1 that goes into school-based resilience programmes, this figure is over £5.

Alongside measurement comes action. What can be done, specifically, to improve the resilience of individuals?

This week, Scope spoke with Amanda Jones, Operations Manager for Resilience and Wellbeing at Action Mental Health (AMH), about the hands-on work the organisation does across Northern Ireland to and try to improve our society's mental health now and into the future.

Programmes

"Resilience is about the prevention of mental illness. Some might say it is a buzz term but it's certainly something that's come more to the fore in recent years, particularly as an aspect of the prevention strategy."

As an organisation, Action Mental Health aims to improve the quality of life of people in NI who have poor mental health or a learning disability. As part of this, it carries out a number of different programmes aimed at building the resilience among different groups of people.

Broadly speaking, these are comprised of group exercises among peers, which is usually "group-work focused, aiming to be informative while also encouraging conversations."

Some examples include:

• Healthy Me - a school-based scheme for Key Stage 2 children (aged eight to 11) supported by Danske Bank "which explores emotional/mental health, healthy lifestyle choices and pathways to effective support through imaginative and interactive play and song."
• Provoking Thought - a programme aimed at young people, aged 11 to 25, which can be delivered in schools, youth clubs or other community settings, and is designed to explore issues around mental health and to encourage discussion. Funds for this are raised directly by AMH.
• AMH Works - a series of workplace sessions that try to improve mental health of employees, and boost the support given to employees at all levels by their employers. The various arms of this scheme are tailored to different parts of the workplace, for example Mindful Manager seeks to equip management with the skills, confidence and knowledge to help protect the mental health of those working underneath them, while also taking care of their own wellbeing. This operates under a social-enterprise model, so firms themselves have to cover the cost of the service.
• Mindset - a Public-Health-Agency-funded scheme targeting anyway aged 14 and over, delivered in youth and community settings in four of NI's five Trust areas.
• The Northern Area Mental Health Initiative - funded by the Social Investment Fund until March next year, this is comprised of interactive workshops in conjunction with its excellent website (a quality resource in itself), and "exists to build the emotional resilience of children and young people aged 8-25, and their key contacts i.e. teachers, youth workers, parents and carers."

Each of these initiatives is adapted as far as possible to its audience (including flexibility within each scheme - for instance, speaking with 12 year olds is different from dealing with 22 year olds and obviously the Provoking Thought scheme takes that into account) but, when it comes to building resilience, there is also common ground.

Note, however, the major funding streams for each; AMH is doing great work finding resources where it can, but it also indicates how much the third sector has to fight for every penny to promote good mental health.

Sessions

Ms Jones told Scope: "Sessions might look at different mental health conditions, and how they impact on people, and how they can be managed. Some sessions would be more focused on thoughts, feelings and behaviours - as well as looking at warning signs.

"A lot of the time they look at stigma, or ask questions about people's impressions of mental health. What does mental health mean? What does good mental health mean? What do those involved know about mental health?

"With younger people, we might ask them about role models, whereas with adults in the workplace a lot of it would be focused on stress, and the impact of stress, and where you can get support."

The Five steps to wellbeing are woven throughout all of the programmes. These are: connect, be active, keep learning, give to others, and be mindful - those are quite blunt shorthand for the five steps, although the NHS website has a nice primer here for anyone who is interested.

Ms Jones says that it is vital that sessions are not some sort of one-and-done occasion. Resilience is a continuing ability; fostering it effectively takes the same approach.

"It's about consistent messaging regarding how to look after your own mental health. This has to continue after any session.

"Signposting support is key. If a young person has a crisis they should feel comfortable speaking about it and know that the support will be there. In any school where we are delivering sessions, we will offer training for teachers to help with this - and also support those teachers more generally. Dealing with the mental health of pupils is not necessarily a huge part of teacher training even nowadays."

The future

In 2015/16 Action Mental Health resilience programmes were delivered to 15907 people; in 2016/17 this rose to 18637; that figure rose again in 2017/18, with support provided to 20,823 individuals, including 14,906 young people.

Ms Jones was keen to stress that, when it comes to good mental health, resilience is far from the only show in town - noting that AMH itself has a multitude of programmes that either aim to help people who are in crisis, or to get people back on their feet as they emerge from a difficult time.

Nevertheless, boosting resilience is a key part of improving our wellbeing into the future and Action Mental Health has identified several things it says are crucial to progress.

In a general sense, there is plenty of good work being done - but rarely enough of it, with some services being "overwhelmed". Northern Ireland has the worst mental health outcomes in the UK as well as the lowest relative level of funding for provision (and, it should be noted, that England, Scotland and Wales could all do with much greater support for this sector, as things stand).

When it comes to specific asks, however, Ms Jones said: "There is a responsibility for this provision to be delivered. It should have statutory funding.

"Some challenges are around layering of services. You want to work alongside statutory services, and other community and voluntary organisations, to try and avoid both gaps and duplication. And of course, other voluntary organisations may or may not be possible partners or possible competitors at any given time. You are always balancing that.

"What we want is for the Assembly to appoint people at a departmental level to work across all departments, to make sure mental health is a key consideration across all areas of governance."

She said AMH's key asks include:

• Ringfenced funding for mental health support
• Greater engagement with the voluntary and community sector at a departmental level
• More partnership working
• The appointment of a mental health champion

Of course, leaving aside the ongoing paucity of the public purse, none of this can happen without a functioning Stormont.