Westminster City Council
Improving the mental health and wellbeing of vulnerable adults through shared learning
Creating and developing healthy and sustainable places and communities
Poor mental health is an issue for the City of Westminster. Therefore promoting mental health and wellbeing is a priority for the Westminster City Partnership Health and Care Network.
Westminster City Council has established ‘Share a Book' reading groups in three of its libraries, targeted at adults at risk of social isolation or living with low level mental ill health. The mental health and wellbeing of those taking part in the reading groups has improved.
The Marmot Review states that limited social integration and loneliness significantly increase mortality. Social networks and social participation appear to act as a protective factor against dementia or cognitive decline over the age of 65.
Social networks are also consistently associated with reduced morbidity and mortality. Reducing social isolation plays an important part in creating and developing healthy and sustainable places and communities.
The health of people living in Westminster is good overall and life expectancy for both men and women is higher than the England average.
But mental illness is more common in the city than elsewhere. Aspects of Westminster's demographic profile are associated with a higher prevalence of poor mental health. For example, half the city's older people live alone and levels of homelessness are high.
Westminster City Partnership's ‘Strategy for tackling health inequalities in Westminster 2009-2016' includes priorities to:
- promote mental health and wellbeing
- address the health consequences of homelessness
- support independent living.
Shared reading is known to have therapeutic benefits in relation to depression and wellbeing. Participation in reading groups brings about improvements in social, mental, and emotional and psychological wellbeing among people suffering depression.
Westminster library service started running weekly Share a Book groups in 2010. This was part of a wider health information project delivered by its health information coordinator. The project aims to use library resources and skills to improve health and wellbeing by working with the primary care trust (PCT), targeting good information and running restorative reading projects.
Who was involved?
A local area agreement grant, through the health and care thematic network, funded the health information coordinator until June 2011. The Inner North West London primary care trusts – Hammersmith and Fulham, Kensington and Chelsea, Westminster – then extended the post to March 2012.
Library service staff and volunteers run the Share a Book groups. The council's transport service provides a free minibus to libraries hosting the groups for housebound members of the home library service.
Both the primary care trust (PCT) and homeless hostels refer people to the reading groups.
A facilitator from the Reader Organisation led the first group for six months. The Reader Organisation also trained two library staff and a volunteer as facilitators.
The problem and how it was tackled
There were two main issues when Westminster established its reading groups.
Reaching the target group
Westminster wanted to reach people at risk of social isolation or living with mental illness.
The council established its first Share a Book group in Maida Vale Library by targeting users of its home library service. These are often older people with limited mobility. They are known to experience isolation and loneliness, and to have few opportunities to leave their homes or socialise.
A minibus transports them between their homes and the library every Wednesday. They are accompanied by a member of the home library service staff who they are familiar with and trust.
The Maida Vale group expanded and two other groups were established through referrals from homeless hostels and
the PCT's Improving Access to Psychological Therapies (IAPT) service. The IAPT promotes talking therapy and self-help for people with common mental health difficulties such as stress, worry and low mood
Each group involves on average eight to 10 people.
Creating capacity to deliver
For the first six months a trained facilitator from the Reader Organisation ran the Maida Vale group. Each session involves the facilitator reading aloud from an anthology of prose and poetry. Both literary forms allow participants to discover new, or rediscover forgotten, modes of thought, feelings and experience.
The facilitator uses these carefully chosen texts to prompt responses, observations and conversations on a range of topics and themes. Participants are encouraged to take turns to read aloud if they wish to.
Ensuring everyone has the opportunity to share the reading, listen and talk to others is important. It takes skill to tease out responses from people with mental health issues or who are unaccustomed to sharing their thoughts and opinions. It needs an appreciation of what questions to ask, and of how and when to draw people in to a discussion.
Paying an external facilitator was unsustainable. So the library service funded two members of staff to attend the Reader Organisation five-day facilitation training courses. Another student on one of the courses offered to run a group on a voluntary basis. This reduced longer-term costs and meant three groups could be established.
Outcomes and impact
The Share a Book groups occupy a special place in the lives of the people who take part in them. Participants say their mental health and wellbeing has benefitted in various ways, such as:
- a reduced sense of isolation and social anxiety, through taking part every week in something meaningful that involves interaction with other people and helps them put their own circumstances aside
- improved recollection skills, through better concentration from listening to other people and encouragement to share their own experiences
- increased self-esteem and confidence, through exposure to classical literature and opportunities to express their views on it
- the forming of new relationships and friendships, including with people from different backgrounds
One summarised the overall benefit of the group by saying:
"I'm all on my own, so coming means I'm not on my own. I go home to my flat and because I've been here, I'm not lonely. I'm happy to be there."
Some members now meet outside the group to socialise.
Bringing together a mix of people experiencing social isolation and mental health issues enriches the experience. Each group combines users of the home library service and IAPT referrals and homeless people with general library users.
Trained facilitators who combine good communication skills with social awareness are critical. Facilitators need to be able to transmit their enthusiasm for books through skilful reading aloud. They must also make sure each individual feels able to share the reading, listen and talk to others.
A staff member who has clear responsibility for health is key to making health-related activities work, but this does not have to be a full-time post.
Running three reading groups every week is demanding in terms of staff time. Participants make great efforts to attend, sometimes having to overcome significant health and other barriers. Ensuring a trained facilitator is always available so vulnerable people are not let down is a challenge.
What could have been done better?
Relations with the health sector could be stronger. Evidence of the impact of the reading groups is not yet strong enough to secure buy-in from health partners. PCT staff turnover has also hampered efforts to monitor the progress of individuals and gain feedback on the longer-term benefits.
The PCT's IAPT team has asked to run a fourth weekly group in another library. It will be targeted at their service users and facilitated by a trained member of their staff.
Westminster City Council is entering into a three-way arrangement with the London Borough of Hammersmith and Fulham and the Royal Borough of Kensington and Chelsea to combine library services. This will enable the three boroughs to keep all 21 libraries open and is expected to save more than £1 million a year.
Mary Enright, Reading, Learning and Community Services Manager
Westminster City Council
An investigation into the therapeutic benefits of reading in relation to depression and wellbeing (PDF, 99 pages, 1.29MB large file) – on the University of Liverpool website.
24 September 2014