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Case Studies

Cracking Up!

Published by Maya Twardzicki
Health Promotion Specialist
Surrey Primary Care Trust
Email Maya.twardzicki@surreypct.nhs.uk
Telephone 01372 201573

A night of comedy and sketches with award-winning comedian John Ryan and friends, raising the lid on mental well-being and taking a light-hearted look at when life gives you a bit of a kicking - proving that laughter really is the best medicine

Cracking Up!

The people we help are...

The general public in the audiences - whose awareness about mental health issues, suicide and local sources of help were raised (a total of 323)

Clients of mental health services who contributed written and art work to the shows (10) and took part in the discussion sessions (20) - they felt a sense of achievement and pride to have their work performed and displayed, and felt they gave insight and made a valuable contribution to informing the script development.

Members of the public who took part in discussion groups - who also may have had their attitudes and knowledge broadened (a total of 60)

What they have said was...

"Excellent show! Very funny & thought provoking. A difficult subject covered very well"

"Topical and sensitive, but funny and effectively highlights issues around mental health"

We set up the project because...

ı         Mental health problems affect a large portion of the population - one in four people are affected by mental health problems at some point in their lives.

ı         The actual number of suicides in the South East is high - because of the large geographical area and population density.

ı         Yet much stigma and taboo still surrounds mental ill health and suicide.  Therefore we needed to present the topic in a way that would not put people off attending the show - hence the use of the commonly used phrase "Cracking Up", as the title for the show.

ı         Men are "hard to reach" with traditional health methods as they visit their doctor less than women and can be less open to talking about their feelings. Therefore we needed to use a different approach to reach men and chose the popular medium of stand up comedy (which can also appeal to men's risk taking characteristics through the opportunity for heckling) 

The change we want/wanted to bring about is/was...

ı         Explore local men's attitudes towards stress, mental well being, mental health problems and seeking help (by running discussion sessions in various settings)

ı         Increase awareness of mental health risk factors and of protective factors and sources of help/support (by incorporating information in the script and having local service booklets at the shows) 

ı         Encourage men to be more accepting of and to access help/support

ı         Provide opportunities for local service users to contribute material to the show (artist development)

ı         Tour the show in key, accessible venues around Surrey (Epsom, Redhill, Guildford, Woking and Leatherhead), advertising it in places frequented by men

ı         Make a DVD to ensure sustainability and enable the show to reach a wider audience in Surrey. Make a promotional DVD to use for marketing the show to other parts of the country.

What we did or are doing

ıApproached accessible venues (theatres and a football club) and negotiated their hosting of the show

ıRan facilitated discussion sessions to explore men's attitudes and knowledge around mental health issues and seeking help (with different demographic groups)

ıProvided the comedian and sketch writer with background information about mental health problems and self-help strategies to inform the script development, alongside the information from the discussion sessions.

ıPromoted and advertised the show - as well as general publicity though the local media, show venue listings and borough councils, we publicised the show using eye-catching posters, flyers and beer mats in venues frequented by men (eg local pubs, take-aways, cafes, working men's clubs, betting shops, gyms and football clubs, employers and Job Centres)

We chose this method because...

•Other successful health related projects with men have found that going out to where men are, has enabled services to engage with them (Health Development Agency 2002). Hence the targetted publicity in venues frequented by men listed above.

•Evaluations of theatre in education approaches have shown drama (sketches/plays) to be effective in influencing attitudes in a positive way and to be a useful tool for influencing emotions such as empathy. Indeed it can be more powerful in influencing emotions and feelings than factual learning (Sawney et al, 2003)    

•Using humour has been shown to be a good way to connect with men about health. The Leicester men's health project showed that audiences engaged with the comedians and related more to the performance. Audiences said they felt the ‘grim realities' of the issues raised in the comedy routines stayed with them long after they had left the performance.

•Creative expression plays an important role in recovery from mental distress (Mental Health Foundation, 2004). The use of the arts in mental health care has been shown to improve communication skills, provide ways for people to express themselves, stimulate creative skills and enhance self esteem (Scaricoff, 2004).

What's happened is...

-The combination of comedy and drama sketches and poetry was considered both entertaining and thought provoking by many audience members.

-Awareness about mental health issues and suicide was raised among the general public audiences (a total of 323)

-The benefits of seeking support were mentioned, information was given about local sources of support and people were encouraged to contact them (this was done in the sketches, by the comedians and by booklets left by doors, ,many of which were taken)

-The taboo surrounding the topics of mental health problems and suicide was reduced and they were 'normalised' through the personal experiences shared by the performers

-The creative skills and talented contributions of service users to the show were recognised (as shown in the audience feedback), thus helping to challenge the association between mental health problems and failure and challenge stigma. 

-Service users who took part in the development of the scripts through facilitated discussion groups, and who contributed written and art work to the shows, felt valued in their contribution and a sense of pride in them being well received by the audiences.

-Members of the public who took part in discussion groups, also heard broader views and increased their awareness about mental health issues.

What we'd do differently...

-For the next show, we are securing support from other agencies  to help with the extensive marketing/ publicity of the show in public places (eg pubs, cafes, gyms, employers etc). As we have learned that personally taking the materials round and speaking to the relevant member of staff, ensures a much higher rate of the materials actually being displayed, than if they were just sent by post. 

-Also we will be doing a more proactive push with the national and local media and actively following up press releases with phonecalls and offers to do interviews.

Evaluation

Three key questions were asked of audiences. Open ended questions were used to gain the fullest qualitative answers: what did audience members think of the show? what was the most memorable part for them? and how did they hear about the show? (to help evaluate effectiveness of different marketing/publicity methods).

-Using a prize draw and the comedian requesting the form to be completed at the end of the show, helped give very high average return rates of almost 50%. 

The audience evaluation is available to others as it is all anonymous.

A full project report will be available after the October show.

This project helped to deliver...

-National Service Framework Standard One - mental health promotion and challenging stigma

-The national and local suicide prevention strategies - particularly around accessing the hard to reach group of young men.

-PSA target to reduce suicide by 2010.

The project is now...

The project is ongoing - with the Leatherhead show still to come on 9th October 2008.

The show will be mainstreamed by becoming available to be bought in for other geographical areas (subject to availability of comedians and actors).  There are future plans to develop a brief presentation/guide to help other people with finding funding, venues and with marketing and publicity.

Additional information or comments?

Come along and see this great show on the last leg of its Surrey tour. And if you are interested in putting on the show in your area, email maya.t@talktalk.net

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Lead Organisation Surrey Primary Care Trust
Geographical Area Surrey
Outcomes Improving health
Beneficiary Age Adults
Beneficiary Groups Boys and men, People at risk of mental health problems
Type of activity Early intervention
Primary Theme Mental Wellbeing
Secondary Themes  

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