Story of a self-management programme that evolved into an equality and anti-poverty programme for a fairer, more resilient community. Professionals and public work together for a fairer community and improved resilience for better mental wellbeing, guided by the voices of lived experience.
COPE was founded in 1991 by a single Chair, with a desire to improve the wellbeing of the people of Drumchapel. It was awarded a grant for £42k from the Scottish Office Urban Aid Fund, secured by the Drumchapel Mental Health Action Group. Drumchapel is in the northwest outskirts of Glasgow, an area of multiple deprivation. It has a five-year lower life expectancy than the Glasgow average. With a background in mental health nursing and social sciences, Hilda Campbell was recruited by the Mental Health Action Group (supported by social work) to undertake a community led initiative to make a difference.
It’s so rewarding offering services at COPE, seeing the change in the clients. And they’re not just left – they can still come back and use the relaxation rooms as well for a ‘wee top-up’ so to speak. It’s great to see the sparkle in a client’s eye who’s previously sat there and thought ‘there’s no way out of this’.
With the support of local volunteers from the Drumming Up Health project, she and her colleague began by canvassing everyone, from people in the street to people in hospitals, the police, local projects, advocacy services and others. They were asked what changes the community needed. Two common responses came back: people who had experienced mental distress were seeking community based services; others highlighted the need to de-stigmatise issues around mental health, so people would access support.
The aims were to:
- Be a community-led initiative, empowering service users to shape the services they wanted, where they wanted them
- Reduce referrals to the main statutory bodies e.g. health board and social work
- Provide access to advice and information
- Increase community led workshops
What has developed since is a wellbeing organisation at the heart of the community that takes a holistic view of the individuals and the community it supports. It de-stigmatises mental health issues, recognising mental distress is often a natural reaction to life challenges. They use the analogy that a person that presents with asthma symptoms may need more than just an inhaler. At the root could be poor diet, financial challenges causing an inability to afford adequate heating or clothing in winter, unhelpful coping strategies such as smoking to help manage anxiety or stress, or any number of other personal circumstances that conspire to create the health issues. Providing an inhaler deals with the symptoms, but not the underlying cause. COPE aims to help people learn to deal with the causes as well as the symptoms.
- COPE secured premises outwith the social work department, shared with the Scottish Association for Mental Health. Later they moved to their own 4000 square foot of purpose built premises, created by local businessman, John Oliver.
- Supervised by social work it developed a steering group with the local community to ensure what was in the survey came to pass, and applied for and gained charitable status. The steering group went on to become the management committee.
- The community wanted the name changed to COPE (Caring Over People’s Emotions) - this has evolved over the years to COPE Scotland, with COPE keen to share its learning widely.
- It began to offer professional mental health services, through individual work, workshops and population-based work, growing from helping 21 people in their first year to over 2000 a year.
- Listening to the voices of lived experience is core to COPE and services have evolved to meet the changing needs of the community.
- Initially serving Drumchapel, it now covers the whole of the West of Glasgow and share learning across Scotland and beyond.
How it works
The environment in COPE is calm and welcoming, much like any private wellbeing clinic. A large reception area with comfortable sofas, soft music and hot drinks leads into treatment rooms. Helen Quinn has provided solution-focused therapy services to COPE for about six years. This therapy explores the root of anxieties, stresses and traumas and involves six-week blocks of confidential therapy (further sessions may be offered). COPE offers goal-orientated interventions using principles of shared decision making. Regular reviews are used to see if what is being offered is working - and if not, what alternatives there may be. Over the course of the work individuals are taught various tools and techniques. Hypnotherapy tapes, for example, can be used to build self-esteem. The team will also look to other services they may need referred to. 'We focus on the person themselves, as in how they take care of themselves,' Helen explains. 'Your body is the house you live in – if you don’t take care of that house it’s going to crumble.'
In addition to the therapy rooms and a workshop space, the facility has two relaxation rooms with massage chairs and solution-focused therapy tools. Clients can use these between appointments, and former clients can drop in for a ‘top up’ session.
A structured approach is taken. There is an assessment of the issues the person presents, the goals they want to achieve, the support COPE can offer, and a discussion about who else needs to be involved and the assets the individual can bring. There are co-designed information packs on a range of issues e.g. guided self-help confidence workbook, confidence affirmation cards and a CD of exercises. These are provided to help support the person’s journey and help people maintain what they have learned. 'We always make it clear that we can’t wave a magic wand and fix everything for people, but we do our best to give people tools that they can use to deal with life’s ups and downs,' says Helen.
Funding and structure
Glasgow Community Planning Partnership Integrated Grant fund is the core funder. Additional funds come through Scottish Government, Health and Social Care Alliance Transforming Self Management in Scotland fund, and from COPE’s own income generation efforts. While all the services offered to the public by COPE are free, they also have a social enterprise company, limited by shares, whose profits are donated to COPE. TLC2COPE offers training, learning and consultancy, including support with community development, for those seeking to purchase services.
COPE is a charity with a strong degree of autonomy, answerable to the community it serves. However, to achieve the results it seeks it works closely with social work, the NHS and other health and care providers. These other bodies may provide support and information, perhaps becoming involved at specific points in projects, such as in giving advice and guidance on the Sanctions booklet (see below), or access the services that COPE can offer. For example, local GPs will make referrals to COPE for individuals that they think need urgent support, which the NHS cannot provide in suitable timescales – COPE is a valued partner in community health and GPs welcome their approach.
COPE supported a local nurse in the Garscadden Burn Medical Practice to secure funds from the Queen’s Nursing Institute for Scotland, ‘Catalysts for Change’ programme. This was to promote lifestyle changes for people identified as at risk of, for example, Type 2 Diabetes. Dr Peter Cawston is a GP with the practice. He has worked closely with COPE for a number of years and finds their approach of collaboration and co-support effective. He noted the value of the ‘Catalyst for Change’ pilot and this programme has continued beyond the period of initial funding and is now core to the practice.
The key to the success of the lifestyle group is that the people going along feel they are there to help other people. One of the men who comes to the lifestyle change group said, ‘I’m not here for me, I’m here for my wife.’ He’s obese, he’s got cardiovascular disease, but his wife’s got diabetes and he’s really worried about her. He said she would never come to the group, but if he went along he could find out all the information, take part in the activities and encourage his wife to make the changes at home. That sense of making personal life changes to help another is really strong.
Dr Peter Cawston
GP, Garscadden Burn Medical Practice
Mapping the development and influences
Since the establishment of COPE, Drumchapel has seen improved connections across the community. People are more likely to feel that they can find solutions within their own community and report reduced isolation, greater independence and increased confidence in dealing with difficult situations like benefit sanctioning. As a result, wellbeing improves and the need for chronic care services is reduced.
To assist with measuring the changes that individuals experience through contact with COPE, they use the Warwick and Edinburgh Mental Wellbeing Scale. This not only gives quantifiable indicators to funders to support grant funding (for results that can otherwise be hard to quantify), but also provides a basis for discussion with individuals about why their score may or may not have changed. In addition, telling individuals’ stories can demonstrate their improved resilience, even if much of their quantifiable scores are static.
It’s so rewarding to do this work because over time you see the shifts.
Listened and gave me hope to rebuild my mental and physical health and made me feel safe.
The service gave me piece of mind when I needed it – the techniques to deal with my problems that COPE has given me have helped so much.
Listened and made me laugh, I feel comfortable and at ease.
After spending her adult life in the army, redundancy was a difficult transition for Kathleen. Increasingly depressed, she approached her GP and her local church for support, but this proved difficult. 'They told me there would be a 12 week wait or a £40 fee for something immediate – I said I might not be here in 12 minutes. And then I phoned COPE and I saw someone straight away.' The suggestion to contact COPE came through her daughter who works in social work and had a client who had used the service. Working with her therapist, Sonia, Kathleen learned a range of techniques to help her to cope with her anxiety, gradually work through her depression and find a reason to want to live again.
She was so impressed with the help she had received that she offered to come back to volunteer. Two years on, Kathleen became a COPE employee. Kathleen is happy to share her experiences with others who come to the centre, helping everyone to understand that they are not alone and that there is light at the end of the tunnel. She also visits groups leading Laughter Yoga sessions.
I just love coming to work, I really do! They’ve looked after me well, and Hilda’s like that with everyone, even clients that are no longer with COPE; she’s still there to support them. For the people who come here, I know what it feels like coming through that door because I’ve been there, so I feel I can offer that level of empathy.
Elspeth reached crisis point in March 2013. Compounding health problems from diabetes complications left her unable to work, then testing positive for the BRCA2 gene and being advised to have a double mastectomy and an oophorectomy was a further blow. Finally, Elspeth concluded that her working life was over and resigned from her busy job as a manager for a newsagent chain. “'Work was supportive and tried to make the job less active for me, but standing behind a desk and giving out instructions – that just wasn’t me. I’m a do-er.'
In spite of the change of lifestyle and health problems, it was a shock for Elspeth to suddenly start having suicidal thoughts. 'I just thought where did this come from? I’d a good family, husband, two teenage daughters, everything to live for. I thought, this isn’t me, and I went to get help.' Fortunately her GP responded swiftly. Along with a course of antidepressants he referred her to COPE. Within 10 days Elspeth had her first session. The therapy she attended taught her how to understand where the anxiety was coming from, deal with it, and start to work out how to live life again.
Over time, as her outlook improved, she found out that there were volunteering opportunities with COPE and started to get involved with her local community, assisting with signposting, helping groups and visiting schools and nurseries in Drumchapel. Through on-going contact with the COPE team, Elspeth suggested she might like to move into doing support work as a job. A year after she had first volunteered, COPE supported her to become a freelance worker for them. She started the craft group at COPE where she taught and supported people as they made new friends and learned new skills. COPE also nominated Elspeth for the Health and Social Care Alliance’s Self-Management Champion of the Year Award – which she won.
A chance discussion about wanting to make more of a difference led to Elspeth’s next big move. 'I think it was around the time of the Referendum, and I’d been talking about something and Hilda said to me ‘You should be a Local Councillor’. It kind of stuck, and in May 2017 I stood for election to Glasgow City Council and won the seat for Drumchapel.'
Not only has Elspeth found her inner confidence and resilience to take up her political life, she also runs Scout groups, does swing dancing and loves her life. And she still uses the tools and techniques that COPE taught her, proving it’s not just the six weeks that matter, it’s how the individuals choose to use what they learn to make the changes they want to see. Both her daughters have also volunteered for COPE.
When asked what the core strength of COPE is, Elspeth talks about two things – the support they provide and the collective experience.
Everywhere else I’ve ever worked, they only tell you what’s wrong. At COPE, though, they tell you what you’ve done right. It gives you the confidence to feel what you’re feeling and knowing. They get the right balance, with everybody. Also, they listen to everyone around them. It’s fully mutual – everyone’s view is equally valid and what they do is truly co-produced.
SNP Councillor Drumchapel/ Anniesland
What worked well and why?
The voice of lived experience
The relationship COPE has developed with the people of Drumchapel and beyond is central to its success. With around 80 new individuals seeking on-to-one support each month, they also offer wider, community based work such as attending other groups, events or offering workshops off-site, for example in local colleges or schools.
It is now embedded in the community, a trusted member that consults and reflects the lived experiences of the people in Drumchapel and beyond. For example, COPE offers an outreach service at Yoker Resource Centre, in recognition of the challenges some people had travelling to their base in Drumchapel. Trust is key to its ability to identify and meet need. Consultation and co-production – working with the community to produce outcomes that truly meet the needs of the individuals they support - are at the heart of COPE’s ethos. Their co-production workshops include representatives of all their stakeholders, including members of other services.
Capacity, not dependency
The COPE team works ‘with, not for’ the people and communities they serve. They recognise the capabilities and resources people have and help them to build on these, improving their resilience to deal with life challenges. They do this without creating a dependency – there is a transaction there. People can contribute or benefit depending on their circumstances at any particular point in time. To get the benefit of the tools they are taught, they need to work on using them; it won’t ‘just happen’. Hilda explains, 'My idea of social work is about creating the conditions so that people can find their own solutions, so you’re not needed any more, as opposed to creating a dependency.' The traditional, more medical, one-to-one model of ‘you are the patient and I will fix you’ does not fit here and is less sustainable than COPE’s capacity-building, co-production model. With the medical model the community does not develop to rely on its own existing, but often under-celebrated, capabilities and resources.
As different services and activities develop the community has taken ownership of some, so that COPE’s involvement reduces. COPE gives full credit for this to the community for taking the opportunity to build something that they own. This reflects the latent capability in the community and the maturity of COPE’s approach.
When the best leaders’ work is done, the people say we did it for ourselves.
A holistic approach
COPE and partners realise many people present to services experiencing stress, anxiety and depression that is moderate but enduring, with a significant impact on their wellbeing and quality of life. Accessing support to meet long-term needs can be a challenge as more services move to briefer interventions, or have costs attached. Sometimes people remain in the system longer than they need to as they don’t see an exit route which works for them, so go on a merry-go-round, moving from one service to the next with no clear goals and focus. Using services becomes the norm as opposed to discussing recovery or better self-management and resilience to pressures.
Their holistic view extends beyond providing a therapeutic approach for their clients. The team at COPE also works collaboratively with external partners to effect positive changes in lives. For example, working with the local GP cluster and NHS Greater Glasgow, funding was secured from the Transforming Primary Care in Scotland fund for a project called Jigsaw. This focused on ‘bringing the pieces together to improve mental health’.
The Jigsaw Project is a partnership initiative, aimed at understanding different stakeholders’ points of view and priorities, uncovering new ways to build connections, resources and opportunities.
Jigsaw aims to build on what is already there and generate new connections between GPs, the community and community based services. This improves the signposting and uptake of local services. It also has a small budget for seed funding. This facilitates the piloting of new ideas to help people with moderate but enduring mental health issues.
The project builds on what is already there, for example, Thriving Places and the Links Worker Programme. It aims to compliment, not duplicate, existing programmes. Like COPE, Jigsaw recognises that poverty and inequality can cause mental distress, so solutions cannot be attained in primary care or health and social care alone.
This is just one example of a large number of ad hoc projects that COPE has been able to influence, develop and support, looking beyond its immediate services to see how its expertise could be applied elsewhere.
An easy service to access
Initial contact is made as simple as possible for the client – only contact number, postcode, date of birth and GP are asked for in advance. On the first day the paperwork is limited to their story, and they discuss what they expect from COPE, any medications and if they are getting any other therapies, to avoid conflicting treatments. COPE also makes the service accessible at point of need:
We pride ourselves on not having a waiting list – each of us keeps space for new referrals each week. If someone is on the phone and is suicidal, you can’t just leave them. We just try to create that safe space until we can help them get something more formal set up.
All therapists have a minimum of five years of post-qualification experience before joining COPE. This ensures they have the expertise to support the issues that clients may be dealing with. Helen’s advice for those seeking to create something similar to COPE is:
- Create something that is easy and accessible
- Make sure the paperwork is not overwhelming
- Build an environment where people can feel relaxed and human
- Accept the person as they are (non-judgemental)
- Build rapport
- Be clear about what you can offer and what the boundaries are, so the person can decide if this is right for them
It is not only the individuals who benefit. The COPE approach also improves the community’s view of support services. What may start as a sense of ‘them and us’, with concern of the consequences of seeking support, is shifting. This reduces concerns about asking for help when it is needed, knowing that the support will be provided with the individual’s best interests at heart and with the opportunity for them to then pay that help forward. This concept of ‘helping others when you have received help yourself’ means that the families and communities also benefit from the support given to individuals.
The team works collaboratively with partners across the NHS, third sector (including the Health and Social Care Alliance, Self Management Network, Voluntary Health Scotland, Scottish Co-Production Network) and overseas organisations to achieve the best outcomes it can for all. Members of the Q Community (The Health Foundation) are committed to quality improvement in health and social care and advocate service improvements being led by the voices of lived experience. This approach means that the learning and benefit is not limited to those in direct contact with COPE.
COPE doesn’t define its role too tightly - it takes a holistic view of lives. To that end, it contributes across the community and beyond – among many other things. This has included donations to the local food bank and petitioning the local MSP on Period Poverty, which resulted in a motion in the Scottish Parliament. Further to this, COPE has donation/ contribution baskets of sanitary products in all the toilets on the premises and has distributed baskets at The Poverty Alliance National Conference 2017. Dignity Baskets, as COPE call them, were also distributed to some local churches. COPE also supports early intervention and prevention such as seeking to address anxiety before it becomes an issue, for example, by running confidence-building sessions with school children before exams to lessen anxiety.
Following a free showing of ‘I, Daniel Blake’ funded by COPE for the local community, a Sanctions Advice Booklet was developed. This was created in conjunction with social work and other partners, including the Child Poverty Action Group, Scottish Health Council ‘Our Voice’ and The People’s Assembly Scotland. The film screening was followed by an open discussion with the audience about what the story might have been if it was set in Drumchapel. This community conversation, alongside COPE’s existing knowledge and experience, was used in collaborated with Glasgow Social Work Services to generate an advice booklet and sample letters for individuals facing sanctioning of their benefits. The Scottish Health Council and People’s Assembly Scotland bought copies of the booklet for distribution across Scotland, substantially increasing reach of the project. The information is also available online at www.cope-scotland.org/index.php/self-care/file-library#108-welfare-benefits
COPE is open to trying and adapting different strategies and activities as it develops. Some new ideas work, some don’t – for example, people had asked for eight-week mindfulness courses, but engagement and attendance wasn’t high and attendance often dropped away. Understanding what the challenges were, such as being able to commit to being in same place for eight weeks, COPE changed its approach to ’living in the moment’. It provided shorter workshops with greater engagement. People wishing to do longer courses are now signposted to other providers who offer this.
The team has also offered informal services such as a craft café and a mood and music group. The latter won an award, however, accommodating both the calm environment needed for individual support and the lively informal groups groups in the same venue, was a challenge. The solution was for community members seeking more informal support to start their own community hub. COPE provided initial support - producing flyers and publicity; providing materials, tea, coffee and soup ingredients for classes; and helping them to secure funding. The Hub is now operating independently - a community-run asset with no reliance on COPE.
Listening to people, COPE learned that it was looking for solutions. As a result, their services became more solution-focused and goal-directed, offering an initial six sessions with further blocks if required, reviewed every six weeks. This meets with COPE’s aim of enabling people to acquire the skills and insights to move on with their life and not become stuck in the system. Sometimes, unintentionally, services can become a crutch and reduce people’s confidence in their ability to cope with life challenges. Overcoming this can be a real challenge and COPE recognises that some conditions may be long term. However, by helping people to recognise their innate strengths and acquire self-management skills, the individuals can feel more in control of their lives. That doesn’t necessarily mean that people no longer require the services, but that their life revolves less around services and more centred on doing what matters to them.
One of COPE’s on-going concerns is that they might yet be missing some individuals that really need their help. It is, therefore, constantly seeking ways to engage with those who may be out of their line of sight.
Organic growth has been important to date. The team at COPE has no aspirations to ‘build an empire’ – they just want to do what they can to ensure that no one is left feeling they have nowhere to turn. To allow those beyond the immediate area and ‘out of hours’ crises to access useful tools and techniques, the team has aspirations to provide a ‘virtual COPE’ service online, through guided self-management. The service can’t be everywhere for everyone as a physical service, however, the coping and relaxation skills that they can teach can be made available to all online.
Last year there was 1.3 million visits to COPE’s website. If one in four people who visited donated £1 it would cover their core funding and provide extra for others. The website is free to use, but COPE is exploring how, as well as connecting with more people online, it can generate income to fund its work. While some need the free resource, other visitors may be willing to donate in return for the improvement in their wellbeing.
- COPE is a facilitator for community cohesion and development
- An empowered team with a driven and creative leader who is entrepreneurial and prepared to try new ideas has been key to the establishment and development of COPE - they aren’t afraid to step beyond their ‘on paper’ remit to deliver improved lives
- The team looks beyond its immediate activities to see what else would make a difference in the community – social listening helps them respond to needs as they emerge
- Dignity, compassion, resilience and empowerment are at the heart of everything they do
- The therapeutic support is done ‘with, not to’ the individuals, who are empowered to make life changes for themselves
- There is often a transaction involved – COPE provides the skills; the recipients are able to pay back in small ways
- A swift response time builds community trust in the service
- There is a culture of collaboration across different sectors and agencies - building relationships through demonstrable results gains the buy-in and trust of professionals and individuals alike and to make a real difference
Acknowledgements and thanks
Thanks to everyone who contributed to this research project. With particular thanks to Hilda Campbell and Helen Quinn at COPE for their insights into the organisation and how it works with its community. Thanks also to Elspeth Kerr and Kathleen for sharing their thoughts and experiences.
This document has been prepared for Iriss by Fay Purves CMRS of Creative Art Works CIC, a Community Interest Company. Unless otherwise stated, design and photography is by Lindsay Snedden LBIPP of Creative Art Works CIC.