SEABREEZE: SOUTH LONDON MENTAL HEALTH PILOT PROJECT!
EVALUATION REPORT MAY 2014!
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Dance United in partnership with!
Institute of Psychiatry at King's College London!
South London and Maudsley NHS Foundation Trust (SLAM)!
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Photography: Pari Naderi!
Seeing the guys so confident really hit me with
emotion. I cannot remember when this last
happened to such degree in relation to a piece of
art. Of course seeing patients I had met on the
ward when very unwell made it more significant, as
did their pride when they rushed to say “hi” at the
end of the show, eager to come and say "look
what I did".
Isabel Valli, Institute of Psychiatry, King’s College
London
Coming in everyday is a bit of a challenge but it’s
something that I needed to rise to and it’s hard, but I feel
good because of it. Seabreeze participant
I've started walking with my head up when I walk
down the street. I used to walk with it down… it does
make you feel more confident.
Seabreeze participant
This has been brilliant, a lot of enthusiasm from our team and clients
alike. It would be great if it could run again! I’ve met with a couple of clients who I can see have
benefited greatly.
Jean Lawlor, Team Manager, Lewisham Early Intervention team
18 young adults started the project and 16 completed it.
The group moved (overall) from below average wellbeing (levels similar to people describing their health
status as poor), to achieving normal wellbeing levels (above the norm for this population).
On an individual level, 13 pilot completers improved in respect of all 7 intermediate outcomes.
Background to the pilot"
High rates of mental health issues are encountered within the constituencies Dance United had
focused on to date so a logical next step was to test the efficacy of a dance-based intervention in a
mental health setting with the ambition to develop a teaching model and choreography suited to this
context. In October 2012 senior personnel from a bio-medical research institution, the Institute of Psychiatry
at King s College, London (IoP) and a front-line clinical team, the South London and Maudsley
National Health Service (NHS) Foundation Trust (SLaM) attended The Place in London and watched
Dance United s Academy beneficiaries performing on stage. Having witnessed the power of dance
as an intervention, a research context started to emerge: a unique collaboration between Dance
United, the IoP, SLaM, two voluntary organisations (Bipolar UK and Rethink Mental Illness) that aimed
to break new ground artistically and medically. The front-line early intervention teams in south London operating within SLaM (STEP, LEO, LEIS,
COAST) were critical in turning an ambition into a reality.
The Need
The partners wanted to test an intervention for young adults aged 18 – 35 living in south London in the
early stages of diagnosis and treatment of schizophrenia, bipolar and other mental health conditions.
The typical profiles included those who had sought help for psychological problems, with impairment in
psychosocial functioning and specific signs and symptoms indicating high risk of bipolar disorder; those
with an early diagnosis of schizophrenia, or experiencing psychosis or being treated by their GP for
depression/anxiety.
The health partners identified three key problems these young adults experience: (1) they often feel
isolated and struggle with interpersonal relationships, (2) they struggle with their body awareness and
physical fitness and this has a negative impact on their overall levels of confidence, (3) they find it hard to
get up in the morning and to maintain energy and optimism, with a liability to over-focus on their
condition and worry about the future.
The broader health ambitions were threefold: (1) to reduce the stigma associated with accessing mental
health services and to consequently reduce the co-morbidity of delayed diagnosis (over 80% of bipolar
symptoms, for example, are detectable by the age of 35). Co-morbidity is a big issue for this particular
client group often resulting from poor social networks and family relationships; drug and alcohol
addiction; psychosis and general development difficulties; and sometimes, involvement in the criminal
justice system and gang membership (Coid et al), (2) to illuminate the fact that modern medications for
these conditions do not impair movement functions. Rather, people in treatment can carry on living with
normal physical mobility and their capacity to dance clearly demonstrated this point, (3) to draw attention
to recent radical changes in the delivery of care model from clinical management to holistic recovery; a
combination of rounded assessment and active focused intervention with the language of pushing
boundaries, positive risk-taking and personal aspirations. Recruitment and Delivery
The participants were recruited by SLaM front-line mental health workers working within the early intervention
teams and Dance United’s pastoral team went to meet with those who expressed an interest and who were
considered at the right stage in diagnosis/treatment/recovery. Every participant signed a consent form for the
collection and use of data and photographic/filmed material. The agreement was NHS compliant and signed off
by the clinical partners.
At the heart of the pilot stood a four-week full-time dance-based intervention, in which participants, recruited by
their clinical workers, learnt how to dance and then rehearsed and performed an original dance work to invited
audiences. They also engaged in trust-building and team-building exercises and shared healthy lunches.
The process was modelled on Dance United’s classic teaching methodology (with 42 teaching points such as
treating the participants as a ‘company of dancers’ from day 1 and paying attention to the quality of movement
from the outset rather than adding on in the latter stages of rehearsal).
The 15-minute dance piece, Seabreeze, was created in a choreographic laboratory by Dance United’s Associate
Artist, Dam Van Huynh, and two of the company’s most experienced dance directors, Ellen Steinmuller and Carly
Annable Coop. Highly regarded for his research work in contemporary dance in the USA, Hong Kong and
Europe, Van Huynh takes a distinctive three-dimensional view of how a person trains, looks, feels and digests
movement through his or her own body. The choreographer and two dance directors were supported by two pastoral support workers from Dance
United to deliver the project. A clinician from SLaM was also embedded in the team.
The participants performed Seabreeze three times at the Jerwood Space in south London.
The Challenges
There were some concerns expressed by the clinical collaborators that working in a highly disciplined
art form might be experienced as stressful so the dance team modified their facilitation style to be
gently persuasive rather than driven; the language of pressure, push and urgency gave way to a
softer style albeit harnessing creative energy and tension and working with high artistic and
production values.
Four ‘role models’ drawn from backgrounds such as post-graduate dance and psychology were
trained and embedded in the group to help maintain focus and energy. There were some concerns that people with these profiles may find it very challenging to get up
every day to attend an intensive project and might not want to be brought together as a group
(which they often seek to avoid because of the associated stigma). Lastly, there was anxiety expressed by the partners that those who took part would not wish to be
filmed. For this reason, the film maker joined in the dance group for the first week and gently
introduced filming in the subsequent weeks. The team took heed and due care and the worries described above did not materialise. Training
Because the participants were patients from the National Health Service there were a number of
safeguarding issues that fell under the heading of the ‘do no harm’ principle and the referral partners
therefore retained overall responsibility for their clients.
In preparation for the project, the clinicians and the dance team exchanged skills and knowledge; the former
experienced dance first-hand and discovered from within how the process brings about embodied shifts, the
latter learnt about models of treatment, medication, duty of care, treatment environments and the ethics
surrounding the collection and use of data. They also spent time in the Maudsley Hospital environment.
The four intensive training days was delivered by visiting tutors: Belinda Sosinowicz Tudor (Trainer and
Programmes Development: Building Resilience, Wellbeing and Happiness with Positive Psychology , Art and
Creativity); Dr Tamara Russell (clinical psychologist focusing on mindful movement practice in mental health) ;
Gloria Ho (the Youth Co-ordinator, Bipolar UK) and Jo van den Bosch (lead arts therapist for SLAM). Dance movement psychotherapy and mindful movement practice are both used within the NHS. The
company found it helpful to spend time with specialists from these two disciplines working within SLaM to
clarify commonalities and distinctions. Dance United’s process aimed to improve participants’ overall mental
wellbeing from a number of angles through an active engagement with professional contemporary dance.
Theory of Change
A theory of change was created to articulate how the activities and their key qualities could bring
about a number of measurable intermediate outcomes leading to three long-term outcomes.
1) Greater satisfaction in interpersonal relationships
•  Improved communication skills
•  Increased level of trust in others
•  Increased capacity to work as part of a team
2) Positive Functioning: improved embodied confidence
•  Improved stillness and bodily control
•  Increased capacity for symbolic expression
3) Positive Affect: raised motivation, energy and optimism
•  Improved resilience
•  Increased optimism
Referred by frontline clinical
staff!
!
Young adults aged 18 – 35 with an
early diagnosis of a mental health
condition!
teambuilding
activities!
Learning dance
technique in
daily class!
Taster sessions
sessions!
Learning a 15minute piece of
choreography!
Being part of a performing dance
company in which all members
must interact effectively to produce
a high-quality artistic result.!
Level of trust :
being able to trust and
be trusted by others!
Working as
part of a team:
negotiating group
solutions to dance
challenges that
require cooperation and
timing!
!
Inputting own material
into choreography via
creative tasks!
Sharing a healthy
lunch and snacks!
!
Being part of a performing dance
company in which all members learn
and perform choreography in order to
produce a high-quality artistic result.!
!
Being part of a performing dance company
and attending every day and overcoming
obstacles and challenges in order to produce
a high-quality artistic result.!
Resilience: having
Three performances of a 15-minute dance piece to invited audiences
audiences!
!
Communication
skills: communicating
effectively when
interacting during
classes and rehearsals!
Satisfying Interpersonal Relationships:
Relationships:!
greater satisfaction in interpersonal
relationships !
Symbolic
expression:
expressing ideas and
feelings through
expressive movement!
!
!
!
Stillness and bodily
control:!
showing observable
moments of stillness,
bodily control and
mastery of movement!
!
Positive Functioning:
Functioning:!
improved embodied
confidence!
Trust
exercises!
Level of
optimism:!
believing in
their capacity
to achieve a
high quality
dance
performance
energy for and
commitment to the
dance project and
being able to
overcome
challenges and
obstacles along the
way!
!
Positive Affect: !
!
raised motivation, energy and
optimism!
Theory of Change – Outcome 1 – Interpersonal Relationships"
Problem!
Clients of mental
health services
sometimes have
difficulty forming
satisfying
interpersonal
relationships"
Activity!
Clients perform as
part of a
contemporary dance
company in which all
members must
interact effectively to
produce a highquality artistic result"
Intermediate Outcome 1!
Improved communication
skills:!
"
• Remembering"
• Listening"
• Speaking with confidence"
• Eye contact"
• Non-verbal communication"
Intermediate Outcome 2 !!
Increased level of trust in
others:!
"
• Executing paired and group
movements such as lifts and
holds"
Intermediate Outcome 3 !!
Increased capacity to work
as part of a team:!
"
• Negotiation skills related to
group dance challenges that
require cooperation and timing"
Outcome!
Clients report greater
satisfaction in interpersonal
relationships"
Theory of Change – Outcome 2 – Positive Functioning "
Problem!
Clients of mental
health services
sometimes struggle
with their body
awareness and
physical fitness
reducing their overall
level of confidence
and mental wellbeing "
Activity!
Clients perform as
part of a
contemporary dance
company in which all
members learn and
perform
choreography in
order to produce a
high-quality artistic
result"
Intermediate Outcome 1!
Improved stillness and bodily
control:!
"
ready to start moving on cue,
impulse control, not fidgety,
clear thinking, clarity of
movement!
Intermediate Outcome 2 !!
Increased capacity for
symbolic expression:!
"
expressing ideas and feelings
symbolically through dance
movement "
Outcome!
Clients report improved
embodied confidence"
Theory of Change – Outcome 3 – Positive Affect"
Problem!
Clients of mental
health services
sometimes struggle
with getting up in the
morning and with
maintaining energy
and optimism,
reducing their overall
level of mental wellbeing"
Activity!
Clients are part of a
contemporary dance
company in which all
members attend
every day and
overcome obstacles
and challenges in
order to produce a
high-quality artistic
result"
Intermediate Outcome 1!
Improved resilience:!
"
Having energy for and
commitment to the dance
project, overcoming challenges
and obstacles along the way"
Intermediate Outcome 2 !!
Increased optimism:!
"
believing in their capacity to
achieve a high quality dance
performance"
Outcome!
Clients report raised motivation,
energy and optimism"
Evaluation Tools
The participants
The clients self-scored at the beginning, middle and end of the intervention on the Warwick Edinburgh Scale
(WEMWBS) (which is used extensively in the NHS to measure change). Matthew Taylor, the pilot s lead
researcher from the Institute of Psychiatry at King s College, London interpreted the data.
They also self-scored on five of the intermediate outcomes using an adaptation of the Recovery Star
evaluation tool which is used in the NHS.
The delivery team
The dance artists and support staff working as part of the delivery team reported back on how far they had
found the training inputs helpful in one-to-one interviews.
The dance team and the support team both independently scored each participant on changes they
observed in five of the intermediate outcomes and recorded these on outcomes stars.
They also evaluated their experience of delivering the project in one-to-one interviews.
The clinical partners
The clinical referral partners wrote individually and anecdotally about their experience of the project and their
assessment of the efficacy of the intervention for their patients immediately after the project and at two
months post-project.
Correlation between tools and
outcomes
Overarching Outcomes positive functioning, positive affect/
interpersonal relationships Intermediate Outcome Improved communication skills Increased level of trust in others Increased capacity to work as part of a team
Improved stillness and bodily control
Increased capacity for symbolic expression
Improved resilience Increased optimism Measurement tool
Participants self-score on WEMWBS
Measurement tool
Participants self-score on Outcomes Star, dance team and support team score participants using same tool
Participants self-score on Outcomes Star, dance team and support team score participants using same tool
Participants self-score on Outcomes Star, dance team and support team score participants using same tool
Participants self-score on Outcomes Star, dance team and support team score participants using same tool
Observation of movement by dance director using the Symbolic
Expression framework
Participants self-score on Outcomes Star, dance team and support team score participants using same tool
Participants self-score on WEMWBS WEMWBS
All questions are scored as follows:
a) None of the time (1 point)
b) Rarely (2 points)
c) Some of the time (3 points)
d) Often (4 points)
e) All of the time (5 points)
1. I’ve been feeling optimistic about the future 2. I’ve been feeling useful
3. I’ve been feeling relaxed
4. I’ve been feeling interested in other people
5. I’ve had energy to spare
6. I’ve been dealing with problems well
7. I’ve been thinking clearly 8. I’ve been feeling good about myself
9. I’ve been feeling close to other people 10. I’ve been feeling confident
11. I’ve been able to make up my own mind about things 12. I’ve been feeling loved
13. I’ve been interested in new things 14. I’ve been feeling cheerful WEMWBS data
Participants data: total scores
listed for the 14 questions
27/11/2013
13/12/2013
18/12/2013
32
47
52
54
54
70
44
57
60
57
68
70
43
56
56
38
48
50
37
47
48
46
48
56
46
49
53
31
38
37
50
48
56
43
55
47
46
49
46
67
69
47
66
46
58
Individual Wellbeing scores (WEMWBS)!
80!
70!
60!
50!
40!
30!
20!
10!
0!
22/11/2013!
27/11/2013!
02/12/2013!
07/12/2013!
12/12/2013!
17/12/2013!
22/12/2013!
Average wellbeing scores (participants with complete
datasets)!
60!
50!
WEMWBS score!
40!
30!
20!
10!
0!
23/11/2013!
30/11/2013!
07/12/2013!
14/12/2013!
21/12/2013!
Analysis of WEMWBS Data
The group moved (overall) from below average wellbeing (levels similar to people describing their
health status as poor), to achieving normal wellbeing levels (above the norm for this population). #
#
For the general population as a whole, the average score is just under 51 [Warwick Edinburgh user
guide page 14]. The participants started below this (mid forties) and for those where all three ratings
were collected, there was a 10 point increase to a final score of 53.9.#
#
For context, a recent evaluation of a range of three-month group exercise projects in mental health
found an average increase of three points from 43 at baseline to 46 at three-month follow-up. (Malcolm
E, Evans-Lacko S, Little K, Henderson C, Thornicroft G. The impact of exercise projects to promote mental wellbeing. J Ment Health. 2013
Dec;22(6):519–27.)
The baseline in the Dance United pilot was similar to that of those taking part in the Malcolm study
exercise groups. This is about the level of people who rate their general health as 'poor' [see User
guide page 18].
The increase of ten points looks very impressive in that context.#
#
A recent evaluation of an internet tool to improve general population wellbeing also showed an
increase of just less than three points over three months: (Powell J, Hamborg T, Stallard N, Burls A, McSorley J,
Bennett K, et al. Effectiveness of a web-based cognitive-behavioural tool to improve mental well-being in the general population: randomized
controlled trial. J. Med. Internet Res. 2013;15(1):e2).#
#
WEMWBS Descriptive Statistics Descriptive Statistics N Minimum Maximum Mean Std. Deviation 16 31 67 46.69 10.403 15 38 69 52.73 8.189 14 37 70 53.36 9.103 WEMWBS
November WEMWBS Dec WEMWBS Dec2 13 Valid N (listwise) Paired Sample Statistics and Comparisons
Paired Samples Statistics Mean WEMWBS November Pair 1 WEMWBS Dec WEMWBS November Pair 2 WEMWBS Dec2 N Std. Deviation Std. Error Mean 46.67 15 10.768 2.780 52.73 15 8.189 2.115 43.86 14 7.472 1.997 53.36 14 9.103 2.433 Paired Samples Comparisons Mean WEMWBS
Pair 1 Std. Deviation Std. Error Mean t df Sig. (2-tailed) -6.067 6.649 1.717 -3.534 14 .003 -9.500 6.136 1.640 -5.793 13 .000 November WEMWBS Dec WEMWBS
Pair 2 November WEMWBS Dec2 Correlations
WEMWBS November Pearson Correlation WEMWBS November Pearson Correlation Sig. (2-tailed) N Pearson Correlation WEMWBS Dec2 1 Sig. (2-tailed) N **. Correlation is significant at the 0.01 level (2-tailed). WEMWBS Dec2 .787** .743** .000 .002 16 15 14 .787** 1 .772** Sig. (2-tailed) N WEMWBS Dec WEMWBS Dec .000 .002 15 15 13 .743** .772** 1 .002 .002 14 13 14 A Graph Showing Degrees of Change for Participants on WEMWBS
Further WEMWBS Analysis
The graph above is showing what happens for individual young adults in the group. The horizontal and vertical
dashed lines are the mid-point on the scale. At base line in November, four participants are below the mid-point,
so these are reporting relatively low wellbeing. At second follow up, one person remains below the mid-point. The black sloping line is the no change line, so out of the group only two have remained where they were. The
green sloping line represents an average of one point improvement on the scale on average across the 14 items
which make up WEMWBS. This suggests that three participants in particular have made substantial change. The
most striking of the three is the one at the left, as this person was below the mid-point on the scale at the start
and by the end of the programme was well above the mid-point.
One person remains below the mid-point: this young woman was often unfocused and found it hard to keep the thread of thoughts and communication.
She found it hard to grasp the key concepts. She needed a high level of one-to-one support and was the most
needy member of the group. She was erratic in terms of attendance and punctuality.
Only two have remained where they were: 1) one was a young woman who had very low self-confidence , was very timid and self critical. She was particularly
harsh in judging her own skills and her performance. She was a perfectionist and set the bar very high for herself
and then failed to meet these exacting standards. After watching the DVD she said she didn’t look as wobbly as
she thought she would. 2) The other was a young man who did not want the project to end and surprised himself how much he liked it . He
fantasised about how others saw him and struggled at the beginning but then when he realised he had been
welcomed, accepted by and integrated into the group, the sense that it would all come to an end, the impending
loss became overwhelming. Further WEMWBS Analysis
The most striking of the three is the one at the left, as this person was below the mid-point on the scale at
the start and by the end of the programme was well above the mid-point: this young woman grew considerably in confidence, and was productively self-critical, appreciated
having a structure and something to get up for in the mornings. She was one of the proudest people
and had the confidence to face challenges and work through them. She worked very hard. Three participants in particular have made substantial change:
1) This young woman was fairly confident and had good dance ability from the outset, the project wasn’t
too big a challenge for her. She came from a stable family and social environment and never
complained about the effects of medication. She had a good body image and was very organised.
2) This young woman was very self-critical at the beginning and made extraordinary progress to the point
where she danced a solo in the final performance.
3) This young woman talked about how much the project had changed her life. She was not particularly
emotionally expressive but was the first person to speak up in the feedback circle and said that things
had improved in other areas of her life.
Outcomes Stars
Recovery Stars or Outcome Stars provide a very easy to use and visual way of measuring progress
(see below the NHS Recovery Star and an example of how it is used in mental health care settings). Recovery Stars are often created by the participants themselves who set their own goals against
which they can measure their progress. However, for a short four-week intervention we decided to
design a bespoke Outcomes Star to measure the project s proposed intermediate outcomes.
The participants self-scored at the beginning, middle and end of the project from 1 – 10 (1 being low
and 10 being high) on the following statements:
• 
• 
• 
• 
• 
My communication skills such as speaking with confidence and listening to others
My resilience: my capacity to overcome obstacles in order to achieve something
My capacity to maintain concentration and focus on what I am doing
My level of trust in others
My capacity to work as part of a team
The results for the group as a whole are set out in the slide below. In the slide that then follows you
can see an example of the outcomes stars that were also produced for each individual participant
showing starting and finishing scores a) changes self-reported by participant, b) changes observed
by dance team and c) changes observed by support team. NHS Recovery Star Model
Typical outcomes that patients self report on
GROUP RESULTS FOR FIVE OF THE SEVEN
INTERMEDIATE OUTCOMES
27th November
2013
Communication skills
Resilience
Concentration and focus
Level of trust in
others
Working with others as part of a
team
TOTAL 13th December
2013
Communication skills
Resilience
Concentration and focus
Level of trust
Work as part of a
team
TOTAL difference
18th December
2013
Communication skills
Resilience
Concentration and focus
Level of trust
Work as part of a
team
TOTAL difference
1
2
2
4
1
3
2
3
1
2
2
1
2
1
5
2
1
2
6
3
4
4
7
3
8
1
4
3
9
2
4
3
4
2
1
2
3
2
4
1
1
1
10
3
1
2
1
5
9
7
11
17
10
12
1
7
1
2
3
2
1
1
1
4
5
1
1
1
2
6
2
4
2
1
7
2
2
4
4
8
3
4
4
2
9
6
3
10
2
1
7
4
1
1
1
2
1
16
3
4
0
0
5
5
5
11
13
20
17
4
-1
-5
-4
-2
-6
-6
3
8
16
-3
1
2
1
3
1
2
1
1
4
5
1
6
2
3
2
2
7
4
4
4
2
8
4
2
4
4
9
2
3
2
2
10
1
1
1
2
1
2
5
4
2
1
1
1
16
0
1
6
2
2
11
14
19
13
7
-1
-4
-3
-5
-9
-6
4
7
12
0
15
Resilience
OUTCOMES STAR:
Communication
skills
Completed by participants showing
changes in 5 intermediate
outcomes for the group as a whole
Week 3
Week 1
Concentration
and focus
Working with
others as part of
a team
Level of trust in
others
OUTCOMES STAR:
Resilience
Example of results for an
individual participant
Communication
skills
Green = support team
Red = participant
Purple = dance team
Concentration
and focus
Working with
others as part of
a team
Level of trust in
others
Measuring Symbolic Expression
The assessment of symbolic expression , involved systematic observation of each individual s
movement qualities and dynamics using Laban Movement Analysis which, …is increasingly
recognized world-wide in the fields of dance movement therapy and in the performing arts as a
common language for communication about movement (Bloom, 2006).
They were assessed for Flow, Weight, Space and Time. Flow conveys varying attitudes towards the
continuity and control with which a motion is performed, either free or bound and is frequently
related to feelings. Weight involves varying attitudes towards physically exerting force and using
one s weight to have an intentional impact on the environment, either light or strong ; it is
generally related to sensing and the physical attitude of intention. Space describes different ways of attending to the environment and orientating one s motions in
space, either indirectly or directly; it is associated with inner impulses related to attention and is
related to thinking processes. Time describes the pace contained in the movement, either
sustained or sudden ; it is related to intuition and decision-making processes.
All 16 pilot completers had developed and expanded their range of movement dynamics.
DEVELOPMENT OF SYMBOLIC EXPRESSION
OVERVIEW OF OBSERVATIONAL FRAMEWORK
Laban Movement Analysis -­‐ Eukine5cs (Effort Theory) EFFORT FACTORS AND ELEMENTS
FACTOR
INDULGING ELEMENT
FIGHTING ELEMENT
FLOW
FREE
BOUND
WEIGHT LIGHT
STRONG
SPACE
INDIRECT
DIRECT
TIME
SUSTAINED
SUDDEN
OVERALL SUMMARY OF OBSERVATIONS
INITIAL OBSERVATION
•  Low level of complexity of factor
combinations - mostly restricted to two
factors
•  Overall lack of attention to Weight factor
resulting in lack of intention and presence
in movement
•  General lack of attention to Time factor
resulting in a lack of assertiveness and
definition of movement
FINAL OBSERVATION
•  Increase of complexity of factor
combinations - two factors and more
•  Increase in attention to Weight factor
resulting in a development of intention and
presence in movement and body
awareness
•  Increased qualitative attention to
individual factors developing and applying
both elements
Evaluation of the training
In terms of readiness to work with this specific client group, the four dance artists and two support team
workers who attended the training scored themselves 8/9 out of 10 following the training inputs as
compared with 5/6 out of 10 beforehand. Belinda Sosinowicz Tudor s training input was very thorough and experienced unanimously as reassuring.
Two of the core messages that helped the team were people are just people and you re not there to cure
them . The dance directors appreciated the focus on language, for example, using, you may , rather than
you will . They were appreciative of the wisdom being shared such as that it is impossible to second guess
what people s triggers might be; that it was a matter of being authentic and having empathy and not
working with conditions . The team also took on board practicalities such as that participants might need
more toilet breaks and more water than other groups because of the effects of medication.
The Bi-Polar UK training was also very well received. The team found it particularly helpful to meet their two
volunteers who had direct experience of this condition.
The team appreciated Dr Tamara Russell s input, particularly comparing and contrasting mindful movement
practice with contemporary dance, such as how the following elements are experienced in each discipline:
pausing, taking notice, bringing awareness back to your breath, being grounded and having an ability to be
still before you begin and setting your intention . The dance directors put into practice her advice to put
your head into your feet in the choreographic lab. Some members of the team reported that the training had unsettled them and raised their anxiety levels
about what to expect. This varied according to people s professional experience, for example, one member
of the team had previously worked in HMP Holloway with women experiencing mental health issues, another
had a background as a dance movement psychotherapist and both these practitioners were less anxious.
Testimony from NHS Referral
Partners
Ann
Bessell"
#
I'm a bit of a hippy and had really enjoyed the taster day (staff training) and found that it had lifted my spirits in a very
difficult to describe way and I thought it was worth trying to persuade a few of my clients to attend. My client is no
hippy but she enjoys dance and she didn't reject the idea out of hand. She was a slightly sceptical and somewhat
reticent about being the "centre of attention", but she agreed that it would get her out of the house in the dark days
leading up to Christmas and might help shed a few of the pounds that the medicine had helped put on. #
#
She was slightly mistrustful of the project. She has faced a lot of stigma and negative experiences in her life, not least
being ill and being a user of mental health services and this has taken its toll, although she covers it up well. We have
successfully "treated" the illness there was something that we couldn't help her get back which the illness had taken some ability to take risks, some self-worth, some idea about her place in the world, belief in others and in herself and
her own abilities. This seemed to be holding her back from taking the next step back into work/education. It was incredibly moving to see her in the Dance United performance, not a shred of self-consciousness, expressing
herself without fear, trusting in others and being trusted by them, both in the group work and in her solo. I had to blink
a few times to believe it was her. I can't believe that there is anything that she couldn't do now.#
#
There are so many other clients to whom I would like to offer this project, so many people with whom we are "stuck"
that we don't quite know what will help them take that next step towards recovery. Too often I feel we go down the
more coercive routes when this happens, rather than seeing if projects like Dance United could make a difference. I
feel sure that with my client or the other participants as ambassadors, they could persuade their harder-to-engage
peers much more effectively than the workers to give it a go. I really hope that the success of this project will be built
on. It is so hard to put the changes into words and of course we don't know yet what long-term difference this will
make to her or the others. However, I do know that if we are truly to operate a bio-psycho-social model and deal with
people holistically, we must offer projects like Dance United .#
#
Dipti Patel, STEP Team Manager, Southwark Team for Early Psychosis
I would like to say that on behalf of STEP, that we really valued being able to offer our service users
another type of "intervention", particularly one based on psychosocial principles. The project
seemed to engage people in an very innovative way and managed to offer a balance of providing
clear boundaries but allowing flexibility based on individuals' needs around their mental health. The very fact that it was not an explicit mental health project but a dance project for young people, but with the knowledge that they all had something in common was appealing to both workers and
service users. I was impressed with how the young people managed to maintain commitment and work so cooperatively and creatively together. It sounds like a very supportive environment was engendered by
all the dancers (DU staff & participants). It would be great to be able to offer our service users more
of these opportunities, - I think the benefits are multiple, both intra-personally (improved self- esteem
& self-worth, confidence building, sense of achievement), interpersonally (team-work,
communication, co-operation, being supportive to others) and in terms of skill building, for example
to be able to engage in other activities/projects/vocational opportunities w.r.t commitment, timekeeping, reliability. These are just a few of my thoughts but I am sure there are many more gains as
identified by the service users themselves.#
We did have one service user who seemed to have a little bit of a tricky time following the end of the
project. It might have been coincidence but it did make me wonder about how the service users felt
about the project coming to an end and how to cope with this. They had after all been immersed in
the project for a intensive period and clearly seemed to have fun, value and benefit from it but to then
be left with a void. If possible, I think it would be useful to have some options for follow on from any
such projects in the future (dance related or otherwise). One suggestion could be that perhaps each
participant has 1 to 1 time with their keyworker and someone from DU to plan next steps or future
goals, basically so that they have something to look forward to and aim for and to maintain the
momentum of well-being and recovery orientated activity.”#
Grace Parkyn, Care Coordinator (CPN), STEP Team"
South London and Maudsley NHS Foundation Trust
“I have just returned from two months leave and been to see SG (a participant).
My gosh I cannot tell you how proud I am of him for completing the project with Dance United - it was almost like being in a room with a different person- his mood is better, his symptoms are
better, he is going out, his self esteem is improved, he was reflective and thoughtful about the last
year, he is spending time with his family again and has a great routine to his day, AND.. his diabetes
is under the best control it has been for a long time.
He is so proud of himself and showed me all his certificates and feedback from Dance United. I wanted to thank you for all the support you guys have shown him and to congratulate you on such
an amazing project.”
Recommendations
Next Steps: to put together a medium size randomised control trial (RCT) to measure longer-term
impact of an intervention modelled on professional contemporary dance training and performance on
well-being. The trial would: (a) seek to replicate what has already been done, (b) look to develop an approach to
maintaining and building on the benefit achieved, (c) look at the cost benefit of the new approach, (d)
undertake comparative analysis with current state of the art and (e) look at a design for a service model.
Post-intervention: to increase post-project support in order to help patients maintain motivational
energy and focus achieved during the intensive intervention by: 1) each participant having one-to-one
time with their key-worker and a Dance United worker to plan next steps/future goals and 2) to establish
the weekly dance provision as soon as possible following the project.
The training: to add a group supervision session immediately following the training inputs to ensure
that the knowledge of what could happen is grounded and fears and anxieties around the client group
can be voiced and put into perspective.
#
Recommendations for Future
Evaluation
Measuring Change: It would be important to examine how persistent any changes are and whether
participants scores returned to their norm after an interval of time.
It would be interesting to explore whether there are any gender differences in response to the intervention or
any noticeable within cohort differences, say between age groups of participants; would the 18-24 years
cohort gain more from the programme than the 25-35 group?
Evaluation Tools: it would also be interesting to add in other measures such as the GHQ (General Health
Questionnaire) which is recognised by government re the analysis of cost benefit, EQ-5D and symptom
scores. A systematic discussion with the participants clinical worker would add immense value, for example, a
semi-structured interview coupled with contextual analysis.
Many people with Bipolar disorder (and other mental illnesses for that matter) keep mood diaries and may
use mood scales as part of their diaries. It would be interesting and potentially very useful to gain access to
these diaries and to look at how mood, mindset, daily life and so on change outside of the Dance United
project. These diaries capture rich information indeed but they are extremely personal and are used
confidentially with therapists but one option would be to create a bespoke mood diary that stood outside
this framework.
Amazing! What an immense amount of co-operation, trust and sensitivity. The dancers should be very
proud of their achievements. #
Dipti Patel, Team Leader, STEP Team, SLaM#
Wonderful performance – a fantastic way to improve self and enhance recovery. I would
certainly recommend that the trusts and commissioners support and fund more similar projects as an
on-going service.
Dr. Raj Johannsen-Chapman, SLaM
Impressed by the teamwork and amount of
effort put into the performance. The performance
was extremely professional and was a fantastic
achievement for all those involved.
Ravi Kaur, Project Oracle
Really impressive accomplishment, showing confidence, trust and enjoyment.
Dr. David Blazey, Head of Social Inclusion and Recovery Projects, SLaM
Loved the focus and concentration and teamwork. Felt very moved when watching an amazing
experience.
Dr. Tamara Russell, Institute of Psychiatry, Kings College London
It's making me feel more comfortable with just being
out of the house and amongst people and around people
and going on the train on public transport… I am
feeling my anxieties are getting lower and
lower.
Seabreeze participant