Fig. 7.1
Number of sessions delivered in years 1–6 of BALP
In years 1–3, a total of 1154 activity sessions were delivered, with a total of 6150 attendances. This equates to an average session attendance of 5.33. In years 4–6, the total number of sessions had increased to 1993, with 9183 attendances. Although the number of sessions fell from year 5 to year 6, the number of attendances continued to increase. In year 4, there were 2615 attendances, in year 5 there were 3003 attendances, and by year 6 the number of attendances had risen to 3565.
The average attendance figures for each activity session are shown in Fig. 7.2.
Fig. 7.2
Average attendance for each session by sport activity
Low participation results in ineffective use of BALP’s resources, so the project team was highly responsive to continually evolving participation rates. However, it is significant that interest in a particular physical activity is not necessarily a good predictor of whether an individual will attend the session; there remains a significant ‘step’ in the participation process between referral and attendance.
Several further initiatives were offered alongside the regular sessions to encourage participation, motivation, social inclusion and transition:
Sport events (e.g. tournaments, leagues)
Transition initiatives linking with public clubs (e.g. tennis, badminton, martial arts, running, cycling)
Education (e.g. coaching qualifications, nutrition workshops, physical activity/mental health awareness)
Evaluation
Alongside the funding award was a requirement for ongoing evaluation, a report of which we provided for years 1–3 in 2008 [19] and years 4–6 in 2012 [20]. The following data sources were included:
Documentation of the activities and sessions
Analysis of referral and attendance figures
Analysis of client feedback sheets
Analysis of BALP Quarterly Reports
Conducting and analysis of service user forums
Interviews with representatives of partner agencies
Interviews with service users
Observations and discussions with service users and staff
Email correspondence with service users
Interviews with coaches
Social scientific methods of analysis were used to explore the data. These included descriptive statistical analyses, thematic analysis of the qualitative data, linking themes with theoretical constructs and aims of the project, and verifying emergent findings via multiple sources of data. Aspects of these findings have been published in book and journal form [18, 21].
Participant Experiences
In the evaluation of years 1–3 [19], service users suggested BALP activities contributed to quality of life, created social inclusion and relationships and provided opportunities for valued and meaningful activity. Positive experiences grouped around five themes:
1.
A sense of meaning in one’s life through providing something to do
2.
Relational experiences through being with and for others
3.
Achievement through improving personal skills
4.
Feelings of well–being and perceptions of positive health
5.
Sense of discovery or adventure through going somewhere and doing something
During this period, nine clients obtained coaching qualifications and BALP received national recognition for its achievements from the National Institute of Mental Health in England . It was awarded the Positive Practice Award for tackling physical health inequalities and received formal recognition from the Chairman of AWP NHS Trust. The 2008 evaluation report concluded that, ‘the project has met all of its objectives and should be considered a beacon of good practice in mental health provision for individuals with serious mental illness through promoting positive health, social inclusion and providing pathways for future employment in sport for individuals with SMI’. These successes helped the BALP team secure funding for continuation.
The 2012 evaluation [20] explored how BALP is experienced by service users. This understanding is critical as it reveals the contributions that an intervention makes to individuals’ lives. The four areas we discuss below shed light on the: (1) personal effects of involvement in BALP; (2) particular strengths of BALP groups; and (3) difficulties people have experienced with BALP groups.
Overall Experience
Overall, BALP is extremely well received by the people who access its sessions. The overwhelming majority of responses and comments were positive and appreciative of the real and tangible benefits service users described. The following excerpts provide a sense of this:
I look forward to the walks on a Thursday afternoon. I find it very therapeutic and a nice, friendly group of people. A good atmosphere. (Male, walking)
I enjoy the football sessions on Friday afternoon at St Paul’s Academy because it is a friendly and safe place to be. My confidence has improved and I have now joined another football team that plays up at the Downs. Playing football at BALP has been a stepping stone in my recovery. (Male, football)
I participate in the health walk on Thursday afternoon … Thursday afternoon splits up my week, giving me something to look forward to … The help I get from this walk and the disability charity keep me going. (Male, walking)
As these comments suggest, the kinds of benefits experienced through BALP are wide-ranging and individual-specific. General strengths include:
The range and variety of sessions available in one place (i.e. a particular venue) and through one programme is valued because it provides a variety of different activities accessible through a single point of entry, allowing individuals to try out and ‘get into’ new activities.
A sense of satisfaction and pleasure from seeing through an activity session—simply ‘completing it’ is valuable in its own right.
Contributing to the development of BALP provision is important to some—a sense of influencing future provision is empowering and motivating.
BALP is sufficiently flexible and adaptable to accommodate changing personal needs; participants described needing more intensive support at some times than others.
Social Structure and Ethos
BALP groups offer something experienced as qualitatively different to public activity groups, relating to the social structure and ethos of the sessions. Many people consider these qualities to be critical to their on-going involvement and the benefits they experience. Participants found the BALP groups to:
Provide a valuable opportunity to make friends with people through ‘built in’ social opportunities both during activity and afterwards.
Be more friendly, welcoming and accepting than public groups; the sessions allow people with similar issues to come together in an ethos of understanding and tolerance of each other’s lives; as one individual put it: ‘No-one’s going to hold it against you that you have a mental health problem, ‘cause they know up front’.
Be more caring than other groups might be—‘they don’t go so hard’; there was a perception that BALP groups were less aggressive than other groups as members ‘go easy’ on each other when necessary and are not overly competitive or combative.
Be characterised by a sense of mutual and reciprocal support because everybody knows what it’s like—‘you’re all in the same boat’.
The importance of the social ethos of sessions can only be fully appreciated in light of the experiences that often accompany SMI. In the words of one individual, it can feel like nothing happens in one’s day-to-day life. Thus, the scheduled and regular activity that BALP offers can be seen as hugely important in a person’s week. As another puts it, BALP sessions are the only time I really see people. The following remarks were made by a female group member:
I started my activities with the self-defence group … and it was the first activity which I started to do after leaving hospital so it was really a very important event in my life … Why it was so important, first of all, because I was recently out of hospital, and I had a really bad self image, because I was still very, very overweight and I was extremely unfit. And because the whole atmosphere of both groups was constant encouragement and support and people around were understanding and no-one was doing negative remarks, I felt that it was a pleasure to do physical activity … Let’s say I wasn’t performing very well, no-one would laugh at me, everyone was really friendly and I felt accepted as I am, so I didn’t have to worry about the problems I had. I probably wouldn’t be so keen to join an ordinary group or gym or do any sporting event if it wasn’t in this specially designed group for people who have mental health problems. I just felt I am able to relax and just do my best, but I don’t have to be perfect, I am accepted as I am.
This account captures eloquently the kinds of issues that many members of BALP have raised—that as a result of challenging experiences of SMI, a socially sensitive and accepting group atmosphere is important. The fact that BALP groups are tailored and targeted specifically for people with mental health problems is a defining characteristic of their success and appeal.
Qualities of Coaches and Leaders
One common item of feedback relates to the qualities of the BALP coaches and leaders. For the most part, this feedback was extremely positive. Personal characteristics (friendliness, accepting nature, relaxed demeanour, respectfulness, flexibility, supportive, approachable, encouraging) were frequently mentioned and highly valued. This is reflected in the following excerpts:
The BALP workers are really friendly and encouraging and not judgmental. (Male, football)
I find the walking group a very relaxed and friendly experience and atmosphere. The most relaxed group I’ve ever been in. I think this is down to the brilliant choice of [names] as group leaders. (Male, walking)Related posts:
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