Wellness café’s to support recovery are ‘so much more than a cup of tea’

0
748

The aim of this article is to set out the development of an innovative, sustainable model of recovery through the setup of peer led wellness café across the county of Donegal Ireland.  The Wellness Café model reflects the therapeutic community model through its peer led community-base which supports the recovery and inclusion of people with a mental health diagnosis in becoming active citizens.  The establishment of development groups across the county which included all stakeholders, service users, community & voluntary sector, mental health teams across all disciplines (psychiatry, assistant directors of nursing, social work and occupational therapy) social prescribers, family resource centres and local café business owners. It is a model of support that exists outside mainstream mental health services and operates from a social rather than a medical perspective.

The underpinning concept to the development of this model was to provide innovative ways in which we support a recovery orientated service delivery and practices to those who have mental illness.  It was designed to support those with what is termed “long and enduring mental illness” and to provide a “what’s next”, targeted initially for service users who actively engaged with services where programmes and activities were “put on” for them, but who had little or no engagement within their own communities.

The objectives of the model was to provide an innovative solution to reduce isolation for those experiencing mental health difficulties, to reduce stigma, to increase supports, to promote wellness not illness, to increase opportunities for service users to feel part of their communities, to abandon the “closed door “provision of supports to service users and create an open safe public space through engagement with local café business owners and to educate the wider community in the prevalence of mental health and the stigma attached.

Context

Mental Health is a hot topic globally gaining more attention than it has done for many years Bronagh Loughlin writing recently in the Irish Times states  “Mental illness is dark. It should never be a fashion statement.  The trend of glamorising mental problems is as bad as stigmatising them” and whilst the key word in all models of cafés is CONNECTION, there is a large population of people with long and enduring mental health difficulties who have been in the system for many years, who still appear to be forgotten.  We all have mental health we don’t all have a mental illness.

A vision for Change (2006) recommended that service users and carers should participate at all levels of the mental health system acknowledging their unique insight and individual experiences of mental health difficulties and as such must play a central role in progressing service responses, plans and developments in the delivery of mental health services.

Co-Production was at the core of the development of the model. Sustained recovery in Mental Health involves a wide range of supports including clinical supports and services, community supports, housing, employment and social integration. Co-Production is where key stakeholders work together to deliver these supports. (Health Service Executive 2017)  The model aligned with A National Recovery Framework for Mental Health 2018-2020. “The importance of lived experience and peer led services has become more established with innovations such as Recovery Education, Peer support and Peer led involvement centres.” (O Connor 2018) and is based on the underpinning principles of CHIME the Recovery Themes developed by Mary Leamy & Mike Slade (2011):

Connectedness – Having social connections in your life, feeling part of your community rather than being isolated through illness, Hope – Having a belief that life will get better, Identity – being identified as someone other than a service user, Meaningful Role – building on the strengths and skills to have fulfilling and self-esteem building activities in life, Empowerment – having information and choices that gives the confidence to make informed decisions on you own life.

“Overall, the emergent priority is the development and evaluation of interventions to support the five CHIME Recovery Processes.  The subordinate categories point to the need for a greater emphasis on assessment of strengths and support for self-narrative development, a new construction of the contribution of the mental health system being as much about developing inclusive communities and enabling access to peer support as providing treatments,  and clinical  interaction  styles which  promote empowerment  and  self-management” (Leamy et al 2011).

There are many versions of wellness cafés. “Frazzled” is a collaborative café project with Ruby Wax and Marks & Spencer.  “Frazzled Cafés is not just for the one-in-four of us who will suffer from diagnosed mental illness at some point in our lives; it is for the four-in-four feeling frazzled and overwhelmed by the stresses of modern life.”( Frazzledcafe.org)  The cafés operate out of Marks & Spencer cafés across the UK usually fortnightly.

Happy Cafés is another new concept which began in the UK, with over 100 cafes globally there is one café currently in Ireland. “The idea is simple and inspiring: a friendly and welcoming place to meet other people with a shared interest in promoting happiness and wellbeing” (Actionforhappiness.org )

Threshold Training Network in Tallaght Dublin provides a wellbeing café 2 days a week in their centre.  People come to connect, socialise, do workshops and other activities to support their wellbeing” ( Route24.ie).

 

The Cafes 

Letterkenny Wellness Café Development Group was established in June 2019.  The group consists of service users and donegal mental health services.

Hosting a Wellness Café in An Grianan Theatre Letterkenny had organically grown.  Participants who had participated in EOLAS  (a programme for service users and family members with a diagnosis of psychosis) service User eight-week programme in Letterkenny were informed of the opportunity to take part in a nine-week programme called “Write to Recovery” 

The placement of the training in An Grianan Theatre Eatery café was not randomly chosen.  The hope was that placing the workshop in an open space that promoted creativity and removed the “closed door” normality of how courses/training or workshops for mental health service users takes place would reduce stigma. “Greater contact with individuals with mental health problems, particularly through shared tasks, has been shown to reduce prejudice. The visibility of service users, for example through the provision of services in community-based settings, has also been found to decrease stigma. Contact itself can be a powerful educational tool” (Vision for Change 2006).

The group embraced the space one participant said “nobody even knows what we’re doing here” it was here the real possibility of the space being a Wellness Café was born.   

As the idea became a real possibility the group discussed extensively the responsibility, commitment and supports they felt they would need for a Wellness Café to be both safe for them and patrons and one that would be both supported and sustainable.  The group appointed a spokesperson and a meeting was arranged with Director of Nursing DMHS to discuss supports from services.  Commitment was given that staff would assist the service users to both develop and run the café.  It is important to note that service users have engaged, directed and invested their time over a total of 27 weeks to the launch of the cafe and continue to do so with energy, commitment and vigour.  They remain determined, focused and advocates for and on the delivery of Wellness Cafés across Donegal so that many more service users can benefit.  

The café was launched in September 2019 at An Grianan Theatre Letterkenny. The Café is self-sufficient and does not require funding to operate, as the venue is free and patrons are charged a minimal cost for Tea/Coffee.  The staff of An Grianan Theatre have been instrumental in their support of the cafe and the ambience created for patrons to feel welcomed in the space provided.

It was always envisioned that Wellness Cafés would be created across Donegal so as a group it was decided to capture the learning.  To this end a co-produced Wellness Café facilitation skills course was developed, the training was the first of its kind.

Funding was received from a local mental health charity to deliver Wellness café Facilitation skills training to a further 5 sites in Donegal with the hope of setting up 5 new cafes and training 25 peers to facilitate them.  However, what we achieved was the delivery of 16 information sessions, training delivered across 7 sites which accumulated in the launch of a further 14 cafes across the county with 50 Wellness Cafe facilitators trained. 

Development groups are key to the functioning and sustainability of the Wellness Cafés in each local area, these groups consist of all stakeholders who meet regularly to support the cafés.  In addition to this there is a regional development group who meet quarterly, this provides cafés with support and often solutions to help grow their cafés and to encourage the participation of people with lived experience in their own communities.  It is important to note that some service users still experienced difficulty in participating in cafés in their own areas and chose to be part of cafés in other towns or villages.  Their reasons for this was stigma attached to their mental health difficulties and people knowing their business.  Having the choice of different cafés to attend supports a person’s right to choice and it protects their anonymity. 

The cafés operate either weekly or fortnightly across the county and remain driven by the development groups.  The absence of funding is not unintentional as in order to have fidelity to the model we stand by the principles of “doing with” and providing a social model which is not “put on for” people.

The model is “so simple it’s confusing” and we often have a need to step in and “do for” especially when things appear that they are not going well.  The cafes however are not about numbers, they are about providing a space and a connection for people with lived experience of mental health issues who want to have the same social experiences as everyone else be that one person or 20.

The model is not without its challenges especially in rural areas where access to transport and seasonal business impacts the continuity.  Development groups however are the cornerstone and come together to make all decisions on the cafés as they develop and grow with peers’ equal stakeholders in these decisions.  Some cafés who initially operated weekly have moved to fortnightly or in some more rural areas two villages alternate.

As part of our continued investment in giving service users opportunities to have access to social connections we have partnered with the last few years with an event in Ireland called “First Fortnight” this event happens the first two weeks of January every year and supports Mental health and the arts.

As part of this festival Donegal Wellness cafes have presented “Pop up Peer Poetry” & in January 2023 will host “What is a flat white” a participatory theatre piece across all cafés co-facilitated by Wellness Café peer facilitators. Patrons to the wellness cafes were given the opportunity to take part in “Write to Recovery “through this those with lived experience of mental health difficulties had a safe creative space in which to explore their narrative about their own mental health journey.  On completion of the workshop’s attendees had the opportunity to present their writing, poetry as part of First Fortnight Festival and at peer appreciation and celebration days of the cafes to a wider public audience

Many people with lived experience of mental health difficulties were not previously exposed to the written or spoken word in a creative space such as this or thought it “was not their thing” and in some cases writing was linked to un-wellness rather than recovery.  To date there has been over 40 participants who have attended workshops and participated in readings and sharing of their poetry and have taken part in many events across the county of Donegal in support of the spoken word and sharing their recovery journeys through that medium.

Evaluation

Several anonymous questionnaires have been distributed across the cafés along with evaluation of the facilitation skills training. When asked what people thought of the cafés the following statements were noted

  1. “I look forward to coming every Thursday, glad to have it”.
  2. “The Café has become such an integral and positive part of my week,  I enjoy meeting the people who come every week”.
  3. “Very good, takes a while to get to know people and there is a lot of advice and people coming in”.
  4. “The very best thing that has come to Letterkenny, I really enjoy”.
  5. “The Wellness Café is a really nice place to meet people”.
  6. “I find it very good, especially for socialising, getting out of the house and finding out about supports”.
  7. “I find it a great event, it gets me out and I meet lovely people as I would call my friends a great bunch of people”.
  8. “It is welcoming, nice to meet and talk to new people”.
  9. “Good, but still hard to mingle with everyone, but the topics they’ve had was good and informative”.
  10. “Very socialising for me, something to get up for”.

Findings from evaluations of the facilitation skills trainings noted that 

  • Good practice was shared
  • More cafes in an area gave choice to those who felt stigmatised in their own areas
  • Café being self-sufficient and attendees paying for their own teas/coffee was also very positive and ensured independence
  • Co Facilitation with other sectors was discussed and the learning from the Letterkenny Wellness Café was met with positive responses.

What was of particular note was where peers received their information about the cafés.  Media campaigns were less effective than the person to person contact in people wanting to be part of the cafés.

Peer facilitators noted that this peer led model supports them to connect and have a meaningful role within their communities, share their experiences in a platform that is safe, with the support of mental health staff, community & voluntary sector and local businesses who were equal stakeholders in the process.

Conclusion

The aim of this article was to set out an innovative, sustainable, cost effective delivery of a space that provides so much more than a cup of tea. If we are to provide a recovery orientated service we must have the mechanisms in place to support that through a pathway to recovery.

Peer support models of service delivery for people experiencing mental health difficulties have increasingly featured in policy and practice both in Ireland and abroad. In fact, some experts have remarked that peer support has “virtually exploded around the globe” over the last twenty years (Davidson, 2013, p.123). Starting with Judi Chamberlin’s landmark publication On Our Own in the late 1970’s, people with experience of receiving mental health services have gradually taken steps to establish themselves as service providers and deliver mental health support. Today, various forms of individual and collective models of peer support exist, including peer support workers working within mainstream mental health services, peer advocacy services, peer-run self-help groups and peer-provided day services; all of which have some evidence of beneficial outcomes (Higgins et at al 2016)

The sustainability and innovation of the Wellness Café model whilst nothing new in its “end product” the establishment of wellness cafés is unique in its merging of theories and practices which creates the environment within the cafes for people with mental health difficulties to not only support their own recovery but to be a collaborator in that process.  Whilst the fidelity of the model continues to be tested especially at those times where we feel we need to step in and “do for”  through an equal stakeholder process by which the centrality of the service users lived experience is at the heart of all decisions continue to be led by the peers who facilitate the recovery journey of themselves and others.

Peer-provided services are services that are run by service users and offer peer support and opportunities for re-integration and independence in the community. Research evidence shows that peer-provided services bring benefit to all stakeholders. The benefits to service users include improvement in symptoms, increase in social networks and quality of life, reduced mental health service use, higher satisfaction with health, improved daily functioning and improved illness management.” Vision for change 2006  Value cannot really be placed on lived experience however services cannot continue to depend on “good faith” from Service users when they are an integral part of the system.  Service Users families and carers continue to support services in the delivery of their promises in organisational change and the embedding of recovery into practice

We are currently testing if the model can hold fidelity within a higher education institution led by students’ union.  It is our intention to research the model more effectively and to create a toolkit to share with any and interested peer groups or organisations.

A vision for Change (2006) recommended that service users and carers should participate at all levels of the mental health system acknowledging their unique insight and individual experiences of mental health difficulties and as such must play a central role in progressing service responses, plans and developments in the delivery of mental health services.

References

Action for Happiness. (2020). Let’s take action for a happier world. [online] Available at: https://www.actionforhappiness.org/ [Accessed 6 Feb. 2020].

Higgins, A., Hevey, D., Boyd, F., Cusack, N., Downes, C., Monahan, M., McBennett, P. and Gibbons, P. (2017). Outcomes of a co-facilitation skills training programme for mental health service users, family members, and clinicians: the EOLAS project. International Journal of Mental Health Nursing, 27(2), pp.911-921.

Hse.ie. (2020). [online] Available at: https://www.hse.ie/eng/services/publications/mentalhealth/mental-health—a-vision-for-change.pdf [Accessed 6 Feb. 2020].

Leamy, M., Bird, V., Boutillier, C., Williams, J. and Slade, M. (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), pp.445-452.

Route24.ie. (2020). [online] Available at: https://www.route24.ie/about [Accessed 6 Feb. 2020].

The Chatty Cafe Scheme. (2020). The Chatty Cafe Scheme. [online] Available at: https://thechattycafescheme.co.uk/ [Accessed 6 Feb. 2020].

The Irish Times. (2020). Breaking News | Irish & International Headlines | The Irish Times. [online] Available at: https://www.irishtimes.com/ [Accessed 6 Feb. 2020].

LEAVE A REPLY

The editorial team for Mad In Ireland accept, style edit, moderate and agree submissions to be published. However, the opinions, experiences and contexts of published submissions are that of the authors and not of Mad In Ireland.