Wellness Recovery Action Planning Edinburgh Carers Support Project at the Stafford Centre Independent evaluation report, December 2014

Summary WRAP (Wellness Recovery Action Planning) is an internationally-recognised approach to maintaining wellbeing. Comprising training and a comprehensive toolkit, it has primarily been developed by and for people who have experienced mental health problems. However, there is a growing body of evidence that WRAP can ‘significantly improve the mental wellbeing of carers’, a view with which this report concurs. The Edinburgh Carers Support Project, part of Support in Mind Scotland, built on the learning from a 2011 pilot of WRAP for carers in designing the WRAP project at the Stafford Centre. Between March 2013 and May 2014, five WRAP training courses were delivered to a total of 42 people. A monthly follow-up group was also created to provide support and encouragement, as recommended by the previous pilot. The independent evaluation took place between September and December 2014 and draws on well-triangulated evidence from a wide range of sources. This report is structured using outcomes and indicators to give a systematic appraisal of the project’s impact. It then explores the WRAP process and identifies challenges before drawing a series of conclusions: 1. WRAP works for carers, providing a valuable space for people to feel comfortable with looking after themselves and attending to their own needs. 2. The Edinburgh Carers Support WRAP project achieved significant outcomes for carers and peer support volunteers:  Reduced isolation, increased social and support circles  Improved confidence and morale, with reduced feelings of guilt  Increased ability, strategies and resources to cope  Improved health and wellbeing 3. Additional outcomes were achieved for carers, who feel better informed and are able to think and act more clearly in their caring role. 4. Courses could be delivered over a greater number of shorter sessions, to make it easier for people to process the learning. 6. Participants appreciated and felt validated by the flexibility of the way WRAP was implemented, so this approach should continue. 7. There are mixed views on crisis planning, and it is worth exploring how it can be usefully addressed for different people. 8. When creative tools are used, it is worth taking time to help people understand the benefits, while continuing to allow for diversity in the tools people choose to use. 9. There is a great deal of benefit in running WRAP for peer groups. Nevertheless, it is worth continuing to offer open or mixed follow-up groups, as there is some interest in the mutual understanding that could arise from these. 10. Follow-up groups help some people to further develop and embed WRAP after courses end. If possible, they should continue to be funded as a core part of WRAP. 2|Page

Contents

Page

1. Background and methodology

4

2. The outcomes one by one

6

Outcome 1: Reduced social isolation and loneliness, 6 increased social circle and connections Outcome 2: Improved confidence/morale as a carer

8

Outcome 3: Increased ability to cope in the caring role

9

Outcome 4: Improved health and wellbeing

12

3. Process

14

4. Challenges

17

5. Conclusions

19

Appendix: WRAP Evaluation Wheel

20

This report was prepared by Graeme Reekie MA MBA CMgr FCMI of Wren and Greyhound Limited, www.wrenandgreyhound.co.uk

3|Page

1. Background and methodology About WRAP – Wellness Recovery Action Planning WRAP (Wellness Recovery Action Planning) is an internationally-recognised approach to maintaining wellbeing, a ‘way of learning to take control of life, through developing resilience and taking on life’s challenges’.1 Made up of training and a comprehensive toolkit, it has primarily been developed by and for people who have experienced mental health problems. However there is a growing body of evidence that WRAP can ‘significantly improve the mental wellbeing of carers’2. In 2011 an evaluation on behalf of Edinburgh Carers Council identified a number of outcomes of delivering WRAP training to carers:        

Decreased feelings of isolation Improved relationships Increased ability to cope Acknowledgement of carers’ rights Increased confidence and self esteem Carers can voice emotions More energy Reduced feelings of guilt

The Edinburgh Carers Support Project - Support in Mind Scotland, which is based in the Stafford Centre, built on this learning and incorporated these outcomes into the pilot of a new service. Between March 2013 and May 2014, five WRAP training courses were delivered to a total of 42 people. Most of these were carers, though one course was run for Stafford Centre peer support volunteers. A monthly follow-up group was also created to provide support and encouragement, as this had been a recommendation of the previous pilot of WRAP for carers in Edinburgh. 3 About the evaluation The independent external evaluation of the project took place between September and December 2014. It draws on well-triangulated evidence from a wide range of sources:  Meetings and interviews with project staff  Focus group with 3 carers, 2 WRAP facilitators and 1 peer support volunteer  One-to-one interviews with 5 carers and 2 peer support volunteers  Questionnaires completed by a further 3 carers and 2 volunteers  Self-evaluation questionnaires and feedback from WRAP workshops  Evaluation wheels completed before and after WRAP workshops The evaluation attempts to understand WRAP in the Edinburgh Carers Support Project at the Stafford Centre as part of a wider context by:

1

‘Wellness Recovery Action Planning: Keeping Myself Well’, Mary Ellen Copeland

2

‘Carers Need Recovery Too: An evaluation of the use of wellness Recovery Action Planning and its effectiveness for carers’, Edinburgh Carers Council 2011 3 Ibid

4|Page

  

Building on the learning from previous evaluations of WRAP in Scotland Adopting outcomes from a national carers’ outcome framework which is itself mapped to the Scottish Government’s Carers’ Strategy and the Talking Points framework4 Clustering the outcomes identified above within these national outcomes, to develop a range of outcome indicators (see table 1 below)

The following section of the report uses these indicators to give a structured, systematic appraisal of the extent to which the project’s outcomes have been achieved.

Table 1: Outcomes and indicators used in the evaluation

Outcome (adopted from Shared Care Indicators (Adopted from the Edinburgh Scotland carers framework) Carers Support Project funding application and previous WRAP evaluation) 1. Reduced social isolation and 1.1 Decreased feelings of isolation loneliness; increased social circle 1.2 Improved relationships and connections 2. Improved confidence/morale as a 2.1Increased confidence and self esteem carer 2.2 Reduced feelings of guilt 2.3 Acknowledgement of carers’ rights 3. Increased ability to cope in the 3.1 Increased ability to cope caring role 3.2 Carers can voice emotions 3.3 More energy 4. Improved health and wellbeing Self-reporting of improvements in health and wellbeing Also: 1.1 Decreased feelings of isolation 2.2 Reduced feelings of guilt 3.2 Carers can voice emotions 3.3 More energy

4

The Easy Evaluation Toolkit, Shared Care Scotland, 2013

5|Page

2. The outcomes one by one Outcome 1: Reduced social isolation and loneliness; increased social circle and connections ‘Feel part of a network of people – Very powerful and moving.’ East Lothian Carer

The evaluation found strong evidence that this outcome was fully achieved. Carers particularly value the opportunity to meet, get support from and share ideas with their peers. This is important because carers commonly reported feeling isolated and unsupported, which puts a strain on their own wellbeing and their ability to cope: ‘You feel like a different person, being out. I needed to find myself again in the whole process. I think I’m quite a strong person but I was so down that I never thought I could be.’ Carer interview Indicator 1.1 Decreased feelings of isolation In response to a question about the most useful element of the courses, the most common answer related to being with other carers, for example: ‘(The most useful thing was) meeting and sharing with other carers. Mutual support’ ‘(The most useful thing was) hearing other carers’ experiences and being able to discuss similar issues’ There was a strong sense among carers of the validation that came from realising they weren’t alone; either with the caring situation or with the burden it places on them. For example, ‘I was just glad to be able to go and speak with other people in the same situation…I just wanted to come and talk to other people.’ Carer in Focus Group ‘The WRAP first got me out there to talk to other people who had problems, in a safe environment. Where else would I have encountered these people?’ Carer interview However, some carers also felt it was important to do WRAP with their peers because of the opportunities for learning, not just about WRAP but about being a carer: ‘We could learn from each other, how they can cope. And that kind of thing helped me a lot… Being together with people who went through similar kind of things, so they understand what’s going on.’ Carer interview 6|Page

‘There’s the learning aspect as well. So if one carer is describing a situation and I think, ‘Would I have done that’, or ‘That’s an interesting way of going about that’ or ‘I’ve had a similar experience’ or ‘That might happen in the future’. There’s more of a learning in terms of being a carer as well as the WRAP.’ Carer interview Indicator 1.2 Improved relationships Most of the carers we spoke to focused on the impact of WRAP on them, rather than the person they care for. Nevertheless, where improvements in relationships with their loved ones occurred they were significant. The change mostly related to what WRAP calls ‘personal responsibility’; in this case carers’ ability to identify and set limits on their own role: ‘(I) now have a good relationship with daughter – closer as a result of WRAP’ Carer Questionnaire ‘It has helped for me to learn that whatever happens I need to take out some time for me. I started doing at least one group a week, because I had stopped everything. I didn’t go out because I was always afraid something would happen at home. It has helped both of us.’ Carer interview ‘It was through understanding the process, realising where you were - I was driving my son’s bus and I had to get out of the driving seat. And then that meant you had to wait and be patient while he got his gears going and put the petrol in.’ Carer interview Interestingly, relationships with friends and other family members were also noted to have improved in two cases: ‘You can say you’re doing the WRAP, they can relax, they’re not responsible for you. That allows you to have some ‘talking time’ with them. And, you know, it makes everybody able to manage. Your children too.’ Carer in Focus Group ‘I’ve found the changes in the family dynamics very difficult through the illness of my mum…(Now) I find managing conversations with them a lot easier because it’s not as emotional, and I think that’s because I’m more aware of how I can look after myself….That is a definite improvement and has not only helped my wellbeing but has helped relationships which otherwise, who knows, certainly would be in a worse position if not severed to some extent.’ Carer interview Finally, there were also improved relationships between the peer support volunteers, some of whom were doing WRAP training in preparation for a volunteering mission to Belarus. In one case, the Edinburgh Carers Support Project and the Stafford Centre worked flexibly to provide WRAP training to a pair of volunteers who missed the group course. This led to the volunteers ‘bonding’, sharing their stories and preparing for supporting each other during the trip ahead.

7|Page

Outcome 2: Improved confidence/morale as a carer ‘Made me realise that I am important. And I need to look after me to look after others.’ Carer feedback

Although the median score in the Evaluation Wheel (Appendix 1) for Self-Confidence only increased from 4 to 5, all 22 respondents did report an increase. Throughout the evaluation there was also evidence of people feeling more in control and able to influence their situations. Indicator 2.1 Increased confidence and self esteem As with Indicator 1.2 (improved relationships), this outcome usually came about as a result of carers recognising their own role – and rights – in the caring situation. This is important because some carers felt their moods and feelings rub off on their loved ones. This can either ease or exacerbate feelings of anxiety, stress and so on. Carers want to approach any caring situation as confidently as they can, and feel the monthly follow-up group helps: ‘(I have) more confidence in realising there are a lot more people like me out there. Made me realise that I need to have a path which I am in control of.’ Carer questionnaire ‘Knowing you can go to someone once every four weeks, and you can ring up – that makes you feel confident. So when you’re dealing with a person, what they can feel is your confidence, not your fear.’ Carer interview ‘(I am) definitely trying to look after myself more. WRAP and Support Group and individual support help me with challenges of life. Need to make some difficult decisions. Not feeling hugely confident today but WRAP has really helped.’ Carer questionnaire Peer support volunteers also reported increased confidence in their volunteering roles: ‘Given me the confidence to continue with volunteering, and to socialise with other people.’ Peer Support Volunteer ‘Having done the WRAP, I feel more confident within myself. I didn’t have a key or a balance to work with before I had WRAP.’ Peer Support Volunteer

Indicator 2.2 Reduced feelings of guilt In the focus group and interviews, carers reported that they no longer ‘dive in’ to support their relatives, but think about what they are doing and feeling first. In some 8|Page

cases this has led to the people they care for taking more responsibility for themselves. In others, it has prevented carers from taking action they would regret. The quotes below illustrate carers’ improved ability to make informed decisions about whether, when, and how to intervene. ‘(I learned) it was okay to say I’ll ring you back in a while. And in the gap he’s got a grip of himself. I’ve done that a number of times.’ Carer in Focus Group ‘There was a guilt-process there I think, and I learned that it was not my fault, and I did what I could, and nobody’s perfect.’ Carer interview ‘I looked at it and thought no, I’m not going to help with that, and I didn’t feel bad about it.’ Carer interview Indicator 2.3 Acknowledgement of carers’ rights Carers didn’t use the language of rights or entitlement. Rather, they described feeling better informed to ‘navigate the system’ or manage their interactions with services. As evidenced several times above, WRAP facilitated this by helping them to put the focus back onto themselves. ‘I think the most important thing about it for me was it put me on the table. I wasn’t on the table. I was scurrying about trying to get answers about my son and what was happening to him.’ Carer in Focus Group ‘It gave me information about better resources… Information about how to handle the professionals a bit better, because I found this very, very hard – to approach them, to get some questions answered, all the secrecy – for me, this was the most difficult part.’ Carer interview ‘WRAP has helped me to try and at least visualise some of it, so that I can be grounded a bit more in what I am. And be able to pull back from my relative’s situation and try and build a life for myself.’ Carer interview ‘It’s difficult sometimes to prioritise or dedicate any time for me, and most carers would probably say that to some extent. WRAP is for me, it’s not about my mum - it’s about me.’ Carer Interview

9|Page

Outcome 3: Increased ability to cope in the caring role ‘Looking at my folder and reading it through reassures me when I am struggling or feeling under par and reminds me of the resources and people that can help me.’ Carer questionnaire Carer Questionnaire Overall, there was slightly less evidence for this outcome than for Outcomes 1 and 2, however there is still good evidence that it has been achieved. Indeed, Outcomes 1 and 2 contribute to carers being better able to cope in the caring role. In the Evaluation Wheels undertaken during WRAP training, all 22 responses showed an improvement in coping skills, with an increase in average score from 3 to 5 (on a scale of 1-8). One course with six carers also used a different scale to help carers assess their coping skills before and after WRAP. The results are comparable with those from the Evaluation Wheel, see Figure 1: Figure 1: Carers’ coping skills

Carers' coping skills before and after support (1 = lowest possible, 10 = highest) 10 9 8 7 6 5 4 3 2 1 0

Before

5

6

6

7 5

After

7 4

6 4

5 5

6 4

2 Carer 1 Carer 2 Carer 3 Carer 4 Carer 5 Carer 6 Average

3.1 Increased ability to cope The way people most commonly described WRAP was as a framework, a structure or a tool. These words, which suggest solidity and stability, reflect the way that people feel supported by WRAP as a process as much as, and sometimes more than, a finished product or ‘plan’. ‘It’s good to see it in a systematic way, because it gives you a sense there is some control here. Because if there is one thing that happens, it’s that the control goes out the window…The fact that it’s systematised makes you feel good, to see it written down.’ Carer in Focus Group

10 | P a g e

‘It’s a bit like a jigsaw. You know all the pieces separately but it puts it all together in a way you can see, ‘Ah, there’s a journey here’.’ Carer Interview ‘I would refer to it as a tool. And that’s helpful for me because I know that it’s something that’s there to support me, where I can pick and choose the support of what’s in my WRAP.’ Carer interview For the peer support volunteers, WRAP was chosen as a way of developing coping strategies and plans for dealing with issues around their own mental health and wellbeing in their role as a volunteer both abroad in Belarus and in the Stafford Centre. Sharing their WRAP with staff and peers again helped people feel there was a structure of support behind them. 3.2 Carers can voice emotions As with ‘Reduced isolation’ in the self-evaluation questionnaire, this was an important theme to emerge from carers’ responses to the question ‘What was the most useful thing about the group?’: ‘…Letting out the problems I have in day to day living. Just listening to other people and them listening to me’ ‘…To have an opportunity to discuss the challenges of being a carer’ This is not just about carers feeling less alone. The space that WRAP provides allows carers to get things off their chest, legitimately and in an environment where they will be understood, is very important. ‘You were always alone with it. You talk to friends, and I’ve got friends who have been extremely good, but then you realise you can’t keep talking to them about this. And so one thing is you’re allowed to talk about it here. And it’s such a relief! And you go out and you go ‘Ahhh’. And that allows you to keep going.’ Carer in Focus Group ‘It’s a safe place to be able to say what you’re feeling. And it’s a safe space for someone to reply back.’ Carer in Focus Group 3.3 More energy Of all the indicators adopted from the outcomes identified in the previous pilot’s evaluation, this is the one that respondents mentioned least often and least explicitly. Some carers mentioned being ‘refreshed’ and some were less stressed, for example: ‘(I) feel so much better, and something is now possible.’ Carer questionnaire ‘I’m not as tired out, burned out as I was before that. I’ve got to a situation where if things happen, they’re outside my control – I’ve done my best without getting caught up.’ Carer Interview

11 | P a g e

‘I am much less stressed now.’ Carer questionnaire There was also a strong sense that caring was an ongoing responsibility and that although carers feel better equipped to manage it, the responsibility continues. Rather than renewed energy, carers were more likely to have gained a new perspective on the situation, helping them to respond in more informed and deliberate ways. Therefore the ability to think and act more clearly is a significant additional or unintended outcome in its own right, as evidenced by the quotes below: ‘Things are in a state of flux constantly, and it’s not just the person being cared for who changes all the time, it’s the carers. And it’s a case of trying to say ‘Right, where are we right now?’ Because if I don’t do that, I go down a line of thought, or even worse, action, that I probably wouldn’t want to go down at that point of time.’ Carer in Focus Group ‘The consequences of the course and support group…allow you to identify the reality of the situation you are in at any point in time more quickly…It’s about lessening the anguish you’re going to go through.’ Carer in Focus Group ‘(With WRAP) there are really good tools in there for putting something together in a situation where you can’t think properly. You can go back and see things from the outside, not from the situation you are in.’ Carer interview ‘What I notice is that I’m definitely taking a different perspective, I don’t get as emotionally charged when having conversations with my brothers and sisters as I probably did prior to the WRAP.’ Carer interview

Outcome 4: Improved health and wellbeing ‘You get the self-knowledge that you need to look after yourself’ Carer interview As well as being indicated by points 1.1, 2.2, 3.2 and 3.3 above, respondents often gave examples of this outcome directly and there is strong evidence it has been achieved for most participants. It was the only outcome all five questionnaire respondents felt they had achieved (the other outcomes all had four people in agreement, with one person ‘unsure’). Indicators of health and wellbeing from the Evaluation Wheel (Appendix 1) include ‘Hopefulness’, which had an increase in average score from 3 to 5, and ‘Self-awareness’, which increased from 5 to 6. In self-evaluation questionnaires during the courses, it was also the outcome people most commonly cited when asked what they thought of WRAP and the difference it had made. The theme was reflected in interviews and the focus group (see quotes

12 | P a g e

below). In one example, improved wellbeing had a knock-on effect on a carer’s employment as ‘I haven’t been off sick again and that’s partly to do with WRAP’. ‘A really useful tool that I use to remind myself of how to take care of my own wellbeing…reminding me what helps when I’m not feeling good...It can’t change the situation I’m in but at times it has helped me look at things more positively.’ Carer questionnaire ‘It helped me to identify stress factors and in writing them down, made it easy for me to reflect and recognise what was important for my mental health... not the sort of thing I would ever have come up with on my own but essential in knowing and understanding what I need to do to help myself. ’ Carer questionnaire ‘I find myself in a state of continuing trauma as a carer…(the onset of my child’s illness) still has an effect on me. That was such a shock. Hopefully that in itself won’t become an entity but I’m fighting against it. WRAP helps me to do that.’ Carer in Focus Group ‘It’s made a space so I can breathe, get over things, work things through, recover, be as well as I can be.’ Carer interview

13 | P a g e

3. Process ‘I almost can’t imagine it in another context than for carers! I definitely see it as being very, very relevant.’ Carer interview

Fidelity to the original WRAP model (which is proprietary and copyrighted) is important to the Edinburgh Carers Support Project and Support in Mind Scotland, to ensure people get the full benefit of everything WRAP has to offer. However, some adaptations were made, arising from the need to make it accessible:   

Delivery 1:1 and 1:2 as well as in groups5 Running a follow-up group to help people embed the learning6 Use of a booklet specifically designed/adapted for use with carers

The outcomes described above, and the learning points below, confirm the findings from the Edinburgh Carers Council pilot and other evaluations – WRAP works for carers, and adaptations can be made to increase its effectiveness. Course materials The course materials were rated as useful by all 13 respondents who completed the post-workshop self-evaluation. Likewise, all 12 people who answered felt the materials were explained clearly and fully, though one person said ‘It might have been helpful to explain that the crisis planning wasn't being done as I was a bit concerned about it beforehand!’ Two out of 12 people felt there were aspects of the course that weren’t enjoyable or helpful. Of these, one said ‘Sometimes it felt a little unclear’ and another identified that ‘I found it difficult to do the crisis planning section’ (it is not clear if this is the same person who mentioned crisis planning above.) The topic also came up in interviews and one person would have liked to spend more time on it: ‘When we came to the crisis bit, because it is how it is and people have painful memories of what’s happened, they kind of just skipped over that bit.’ Carer interview Staff and facilitators are of the view that with WRAP one size does not fit all (see below). It is therefore worth exploring further how crisis planning can be usefully addressed for different people. Flexibility and creativity One of the most important examples of flexibility, and the belief that one size doesn’t fit all, is that the Edinburgh Carers Support Project does not require WRAPs to be written. This is in keeping with WRAP’s original intent, but is even more important in 5

6

and The Edinburgh Carers Council evaluation proposed both of these as useful and appropriate adaptations.

14 | P a g e

a service where 45% of people have literacy difficulties7. Participants identified this flexibility and felt validated by it: ‘I was very aware that it was very much forgivable not to fill it in. But I also knew the facilitators required a bit more engagement with it, so that was great for me because I thought ‘Oh that’s all right then, whatever I am is okay.’’ Carer in Focus Group ‘The WRAP can be written or pictorial…I think it’s quite flexible and I think that encourages more people to engage with it…There’s permission for whatever people feel they want to do, what works for them.’ Carer Interview There were mixed views regarding the pictorial and creative elements of the WRAP course. Two peer volunteers felt this was not helpful for them, while three carers wanted more of it. The quotes below illustrate these different views: ‘I’m really not one of these people that likes to cut out pictures from magazines, I like to go into things a bit more in depth. I found that kind of aspect of it…I almost felt a wee bit patronised.’ Peer volunteer interview ‘(My wish would be for) a bit more interaction with pictures, bring a bit more arty stuff.’ Carer interview This is clearly too small a sample to draw too many conclusions. However, it would be understandable if some people with mental health problems feel patronised by creative approaches, because historically there has been a prejudiced misunderstanding that mental health problems affect intelligence. So, when creative tools are used, it is worth taking time to explain why they are useful (e.g. making activities more accessible, enjoyable or less threatening), but continuing to allow for diversity in the tools people choose to use.

Follow-up sessions All ten people who responded felt they had the confidence to further develop their WRAPs after the training ended. As one carer said, WRAP training itself opens new doors for people; ‘Even if people just attend the WRAP sessions and no more followup work or anything else, at least they’ve dedicated that time to themselves and it’s opened their minds to the possibility that maybe there are other things out there that could help.’ Carer interview However, of the ten people above, four gave further comments, three of which related to needing to set aside time for WRAP, and one which related to finding follow-up support useful.

7

‘The Right Support at the Right Time’, Stafford Centre Evaluation Report 2014

15 | P a g e

The need for follow-up is not unique and has been identified in other WRAP evaluations in Scotland.8 In the Edinburgh Carers Support Project, the desire mostly related to being prompted to further develop individual WRAPs: ‘(It would improve WRAP to) make a regular time to revisit my WRAP’ Carer questionnaire ‘I just find - where’s the time?! There just seems so much time not to do it…I feel you really need a once a month WRAP top-up. I’ve missed the follow-up group.’ Peer support volunteer However, two carers also identified an interest for subject-specific followup sessions: ‘A follow-up session about what would a crisis be, and how would we manage it would be good.’ Carer interview ‘(WRAP could be improved by) follow up sessions focused around a topic which could help people maintain their wellbeing e.g. meditation, outdoor activities.’ Carer questionnaire For others, follow-up is part of the ongoing nature of WRAP, which sometimes benefits from additional support: ‘The support/follow-up meetings were quite good…Just to know that you’re seeing somebody regularly gives you the support that you need to keep going.’ Carer interview ‘I think the WRAP is ongoing, it’s never complete. It’s probably more of a continuous process, and I think that’s one of the aims of the WRAP follow-up sessions is that it’s kept live so people are revisiting it regularly.’ Carer interview Future funding of WRAP should therefore include provision for follow-up support, ideally in a group format, as this has been successful to date. If it is not possible to provide follow-up, another suggestion is to make case studies or materials available to help other people understand the benefits: ‘It’s a useful tool. But there’s not that much material out there. If you look up WRAP, it’s all copyrighted and you can’t get at it unless you go through the course. Maybe something like a case study or a few ideas – not something prescriptive, but something that shows how somebody did use it and what you can get from WRAP.’ Carer interview 8

For example ‘Carers Need Recovery Too: An evaluation of the use of wellness Recovery Action Planning and its effectiveness for carers’, Edinburgh Carers Council 2011; and ‘An Evaluation of wellness planning in self-help and mutual support groups’ Scottish Recovery Network 2014

16 | P a g e

4. Challenges Time A challenge identified in this evaluation is also shared with the other evaluations of WRAP in Scotland previously referenced9: it would be useful to run the courses over a greater number of shorter sessions, as this exchange from the focus group shows: WRAP facilitator: I wish that probably we had more time but split up, the days are too long. As a facilitator I found it a really long day. Carer 1: It is intensive. WRAP facilitator: Maybe doing it over three part-day sessions Carer 2: That would be a good idea, because it gives a little time to reflect and realise there is something to go back to. This suggestion was explored in interviews, where it was unanimously accepted as a good idea, for example: ‘I think half a day, shorter bursts. You can get a wee bit brain dead.’ Peer volunteer ‘My only gripe is that there should be more time. To squeeze something as deep as that into two days was just - it could have been ten days to two weeks. I just felt it was too short, there was so much to take in, there was so much to think about.’ Peer volunteer Interestingly, the suggestion also came up unprompted in a carer’s answer to the question of how WRAP could be improved: ‘Reduce the length of a training session from 6 hours to 3 hours as I was ‘punch drunk’ by the time the session finished.’ Carer questionnaire Peer groups – or mixed? It was generally felt that it helps to run WRAP in groups of peers, i.e. carers or volunteers. This was partly to allow space for people to be honest and unguarded, but also, as noted in Indicator 1.1 above, to create more learning opportunities. ‘Definitely, all carers. In our group, someone needed to talk and talk, because she couldn’t talk anywhere else’ Carer interview

9

‘Carers Need Recovery Too: An evaluation of the use of wellness Recovery Action Planning and its effectiveness for carers’, Edinburgh Carers Council 2011; and ‘An Evaluation of wellness planning in self-help and mutual support groups’ Scottish Recovery Network 2014

17 | P a g e

‘It’s for everybody…everyone’s coming here for themselves to look after themselves. (But) it does work best in peer groups in my experience.’ Facilitator in Focus Group Nevertheless, it is worth continuing to review this approach. One of the things that makes Support in Mind Scotland unique is that it supports (and is led by) carers and people with mental health problems. This could be a strength to build on. As one peer volunteer noted, carers could get ideas from people who have experienced mental health problems, though they also accepted that a WRAP follow-up group might be the best place for this: ‘I think both coming together could be a good idea. You could get other people’s points of view and get to meet people; maybe they are just caring for one person. Maybe can get ideas (and) they can get support from people (with mental health problems) as well.’ Peer support volunteers. A carer concurred, reflecting on his own experience and seeing WRAP as a possible springboard to increased mutual understanding between carers and people with mental health problems: ‘The idea of ‘us and them’ is a huge area to explore…and I would like to see that happen. Where you have your experienced facilitators in WRAP support mode. Where you had, let’s call them carers, and we’ll call them users but it’s not the right name. That would be my wish….It’s breaking down the ‘us and them’ perception. There is a barrier there, even if you have a willingness to understand, and that exists on both sides of the so-called divide.’ Carer interview

18 | P a g e

5. Conclusions 1. WRAP works for carers, providing a valuable space for people to feel comfortable with looking after themselves and attending to their own needs. 2. The Edinburgh Carers Support WRAP project achieved significant outcomes for carers and peer support volunteers:  People are less isolated, have increased social and support circles, and in some cases have improved family relationships  Improved confidence and morale, with reduced feelings of guilt  Increased ability, strategies and resources to cope  Improved health and wellbeing 3. Additional outcomes were achieved for carers, who feel better informed and are able to think and act more clearly in their caring role. 4. Courses could be delivered over a greater number of shorter sessions, to make it easier for people to process the learning. 6. Participants appreciated and felt validated by the flexibility of the way WRAP was implemented, so this approach should continue. 7. There are mixed views on crisis planning, and it is worth exploring how it can be usefully addressed for different people. 8. When creative tools are used, it is worth taking time to help people understand the benefits, while continuing to allow for diversity in the tools people choose to use. 9. There is a great deal of benefit in running WRAP for peer groups. Nevertheless, it is worth continuing to offer open or mixed follow-up groups, as there is some interest in the mutual understanding that could arise from these. 10. Follow-up groups help some people to further develop and embed WRAP after courses end. If possible, they should continue to be funded as a core part of WRAP.

19 | P a g e

Appendix: WRAP evaluation wheel The Edinburgh Carers Support Project makes good use of continuous self-evaluation to gauge progress against a number of core outcomes for the Project. These are slightly different from the four intended outcomes of this particular project. Wherever possible, this report relates the evaluation wheel results back to the four project outcomes, as the data, which is quantitative and shows progress from clear baselines, provides useful triangulation of some of the other evidence used.

WRAP 2013-2014 Self awareness 8 7 6

Selfconfidence

5

Hope

4 3 2 1

Before

0

After

Feeling supported

In control

Coping

Before After

Self awareness Hope 5 3 6 5

Feeling supported Coping 3 3 5 5

In control 3 5

Selfconfidence 4 5

20 | P a g e