Partnering Curiosity with Creative Connections Through the Change Minds Project : An Integrated Commununity Case Study

Partnering Curiosity with Creative Connections Through the Change Minds Project : An Integrated Commununity Case Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Partnering Curiosity with Creative Connections Through the Change Minds Project : An Integrated Commununity Case Study Sally Hardy, Laura Drysdale, Gary Tuson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4730707/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Providing sustainable mental health and wellbeing interventions for those living with serious mental illness remains an area of research interest and therapeutic improvement priorities globally. Any search for progressive mental health treatments often seeks to move away from traditional and historical approaches in search of novel innovations. The Change Minds project embraces the past as a significant data source for enabling those living with mental health issues to find creative connections, exploring how to think differently about what can be learned from the past that promotes living well with a mental health diagnosis. Change Minds is delivered in a unique tripartite organisational partnership approach, bringing together the National Archive Record Office, with local mental health service providers, linked to the original charity host, The Restoration Trust. For three years Change Minds has brought together small social groups of people living with mental health issues, supported by their mental health services, and introduced them to the process of searching local archive asylum records. The Change Minds project facilitates participants through researching asylum case records, identifying and following aspects of interest and curiosity about the daily lives of past asylum personnel. The project ends with participants seeking to represent their own research insights through a creative output or artefact of choice. Old and new social connections, creative expression and peer support have been tried and tested across several sites in England, to produce significant well-being outcomes. The project offers tangible evidence of personal growth, confidence and connection, in contrast to participants prior experiences of living with a serious mental illness such as consequences of social isolation and long-term internal turmoil, as a novel case study of integrated community care provision. serious mental illness wellbeing social connectedness integrated partnerships community assets BACKGROUND People living with severe mental ill health remain one of the most marginalised groups in society (Killaspy et al, 2022 ). Social factors inherent in mental health prevalence are an important aspect of both mental health prevention and searching for improvements to treatment options to address a growing global burden of mental health problems (WHO,2023). Yet, progress over the last decade of research has tended to centre on improved understanding of neuroscience and neurobiology, whilst investigating the psycho-social factors of mental health issues has lagged in comparison (Kirkbride et al, 2024 ). Traces of the past can be seen in how mental health and concepts of ‘madness’ are understood and treated within and across global society today. Madness, when considered a prolonged or acute period of mental ill health, has long been an area of curiosity, fascination, fear, myth and legend. There is a significant point in understanding historical concepts of mental illness, when describing this as an ‘embarrassment of riches’ (Berrios and Porter, 2019 : Preface); as where different interpretations and perspectives continue to bring academics and clinicians together, searching to achieve new insights and information from which to continue to seek to help those who remain poorly understood. Historical fascination to seek a cure for mental health has led many societies to see the person as possessed by an external force, in turn leading to thoughts of a spiritual demonisation as explanation for any signs of oddity. In association treatments were sought from religious priests, shaman or through physical bloodletting, beatings and other forms of public humiliation (Showalter, 1985 ; Porter, 1987a , 1987b ; Szasz, 1960 ; Goffman, 1961 ). In the medieval period, mental disturbances were believed to be influenced by astrological changes, with astrology remaining a part of a physicians’ classical training until the 18th century (Rawcliffe, 1999 ). Mental ill health remains a social and politically contentious issue. Historical concepts of madness remain linked to the current, or most dominant conceptual system at any given time in society, whereas from a social historian viewpoint society’s understanding and treatment of mental ill health has not altered much since the period of enlightenment, which stressed notions of reason and rationality (Foucault, 1971 ; Porter, 1987a /b). In the United Kingdom the Parliamentary Human Rights Act ( 1998 ) expressly identified freedom from inhumane acts or degradation, which has helped promote inclusive strategies for how individuals are being treated within society. Social media has brought a level of exposure and increased awareness of mental health issues, which has been linked with people’s willingness to speak more openly about their own mental wellbeing, both in the workplace and in public (Robinson, et al 2019 ;Daniels et al, 2021 ). Sir Michael Marmot’s (Marmot et al, 2020 ) report shows little progress has been made in addressing social determinants of ill health, where poverty, housing, and geographical locality all have potential negative impact on a person’s life chances and health related longevity. Therefore, improving someone’s health not only extends their life years, but it can also ultimately improve their long-term chances of modifying social risk factors. Some would argue, good mental health is synonymous to social justice. Using a social justice approach to addressing mental wellbeing is an under researched area. Yet, addressing health inequalities, through good integrated care strategies, where partners are working in close collaboration to utilise resources, expertise and local assets, has become a favoured approach to contemporary health and social care integration. Social prescribing in the UK (NHS England, 2024 ) has contributed to the notion of seeking community driven support, helping those living outside of hospital and other institutional settings to integrate, through linking them more closely with what support systems are available locally. Social prescribing has offered one of the most significant shifts in care provision over the last decade, bringing a new form of connection for people across their community, yet issues of how social prescribing helps people with severe mental ill health has proven to be limited, apart from providing connections to services outside of statutory care organisations, with some identified improvement in addressing aspects of loneliness (Foster et al, 2021 ). Since July 2022, England has introduced Integrated Care system architecture, from which to engage in innovative new ways of providing care packages for people, based within their location, community and social contexts. Through utilising this case study approach to monitor impact potential of community driven innovation, the Change Minds project offers one such model where local innovation has offered new partnerships, (across health, local government, and charitable agencies), to achieve health and wellbeing improvements to people who remain on the periphery of a traditional acute based service provision model. Working this way, as a facilitated approach to integrated service advancements, the Change Minds project offers a social emancipatory approach to addressing long term connected communities, that is being evaluated for scaling up. Yet, there is confusion when seeking to measure outcomes of social interventions, particularly when these are peer-led, or co-led interventions for people living with mental health issues (Killaspy et al, 2022 ). Social outcomes associated with these socially based interventions are inherently difficult to measure, due to variability and therefore pose challenges to verifying outcomes at scale. Achievement locally have been identified, when taking an integrated care approach, in seeking to identify an evidence based, culturally sensitive and sustainable universal programme of care that can enhance a person’s wellbeing, through improving their skills and confidence to live well within their local communities and connecting them with their local services to further enable their own strategies for coping well with their health condition and are gaining attention for scalability. This paper offers a case study review of a novel tripartite partnership approach for people living with a diagnosis of serious mental illness, seeking to offer a locally driven place-based model that can be adapted to other localities through effective integrated partnerships. Greater cross sector collaboration to achieve inclusive outcomes has been at the core of this project, in line with the integrated care approach to health and social care. Through reporting on activity to date, it is intended that others might be interested to utilise this as a partnership model for engaging across different local resources more effectively, through the Change Minds project format. METHODS This paper evaluates the Change Minds project 1 , as an innovative partnership approach that links heritage archive records with mental health service providers and is offered to people living with serious mental illness to support their well-being recovery. It is a unique project that incorporates exploring personal case records of asylum inmates, from 18-19th century, as a curated method of social engagement for those living with mental health conditions, through learning lessons from the past, connecting these to today’s experiences of well-being. Change Minds is a National Lottery Heritage 2 funded project that offers access to a central resource hub hosted by a partnership between the Restoration Trust and the Norfolk Record Office. Trialled through several iterations achieving the final 12-workshop programme, five location sites are the source of evidence for this case review. The Change Minds Hub offers the main resource for accessing all project materials needed to achieve a well curated process of archive research, peer learning and social connection as real cases of asylum care from the past are transported into contemporary creative expressions. The hub provides training manuals, project branding, recruitment leaflets, an established evaluation approach, and even provide some petty cash to make the delivery of Change Minds as efficient and effective as possible when starting up in new locations. The Change Minds project has taken place at 11 different sites across the UK, with multiple forms of evaluation underway at each site, using both informal and formal means of capturing activity and outcomes. Each of these elements of activity have been used for capturing data from which to map indicators of success against the Five Ways to Wellbeing (Government Office for Science, 2008 ). Ethical approval was obtained, before offering participants and stakeholders voluntary status to take part in the evaluation, with an open invitation to undertake survey data, and personal interviews with assurance their engagement in the evaluation would not impact their ability to take part in the Change Minds project. Access to the Change Minds project learning and ethical consent related resources are accessible to other interested settings, such as schools, colleges, forensic settings, military veterans and University students. An objective thorough evaluation is nearing completion, whereas this paper captures five of the early site delivery data. Well-being is frequently identified as how an individual seeks to achieve their physical, mental and psycho-social aspects of self, through where and how they seek and sustain pleasure and happiness in life, avoid pain and therefore achieving human flourishing or thriving in life, as opposed to merely surviving in the modern world (Ryan and Deci, 2001 ; Farrier et al, 2019 ). Well-being offers a useful approach to understanding a holistic and personalised benchmark, from which to understand health status, as opposed to more traditional medically focused measures of health and illness (Aked et al, 2008 ). Five ways to well-being The five ways to wellbeing are reported to be a flexible framework that allows its application across multiple diverse project participant groups (Farrier et al, 2019 ). The five ways to well-being are based around the principle of feeling good and functioning well (20). There are five associated recommendations for people to engage with that promotes their individual well-being. These are: Be Active – increasing or ensuring there is physical activity each day, with recommendations of at least 20 mins walking per day to reduce risk of heart disease, for example Take Notice – building upon notions from Eastern philosophy’s mindfulness, this aspiration encourages a person to take time to notice the world around them, and to reflect on daily experiences, appreciating the here and now, rather than worrying about the future Keep Learning – through remaining curious, to understand more of the world, and building confidence through remaining open to learning new things Give back – providing the chance to feed forward and give back build’s confidence and a sense of pride in contributing to either the local community, one’s family and friends. Often seen as encouraging people to take a first step in volunteering, as a person rebuilds their life after a period of ill health. Stay Connected – keeping in touch with a social circle, trying to make connections within a social network, is shown to increase a person’s sense of purpose and address loneliness and risk of social isolation. Mapping the Change Minds’ documentary evidence to the five steps to well-being, offers an initial theory of change (Connell and Kubisch, 1998 ) to capture the inputs, outputs and consequences of the project format, offering an integrated, place-based approach to supporting people living with long term serious mental health, within their local context, linking them to the historical past notions of asylum. This case study evaluation reviewed seven main documentary data sources as a secondary data analysis approach (Hakim, 1982 ). These included 3 interviews with the Change Minds Project leads, assorted documentary evidence including information contained within a project outcome known as ‘Dr Hills Case Book’, (2021) exploring information available via the Change Minds Website, and access to 5 project evaluation reports from external partners undertaking a funded evaluation of Change Minds as part of the funding received via the National Heritage Lottery fund (achieved in 2022). Written project evaluations were reviewed from the Change Minds project evaluation team, delivered at the Museum of the Mind South London delivery (6/23MoM), Norwich Prison (6/23HMP), then at Lancaster (6/23L), Dundee (4/24), and at Kings Lynn (8/24). RESULTS The age range of Change Minds participants varied from 15 through to 76 years (average age = 41). Each cohort size varied from 5 participants, through to a maximum of 18. Ensuring the participant cohorts remain manageable, for attending the Research office space, and to encourage the peer support elements of working closely with a consistent group over the 12 sessions of the project period. Below is a table that captures demographic data of participants who self-reported through use of project written feedback sheets made available for this case study review process. Prior to this Change Minds project was trialled at two sites during 2015/16, then again in 2018/19. The scaling up approach is what has been captured in the table below at five sites during 2022–2024. Insert Table 1 : Change Minds participants’ demographic data recorded at five delivery sites. Table 1 Change Minds participants’ demographic data recorded at five delivery sites. Location Date Participant Age Range Ethnicity TOTAL Museum of the Mind South London June 2023 22–72 years 2 White British 1 Preferred not to say 1 Asian/British/Indian 1 Mixed Jewish 5 HM Prison Norwich June 2023 20–53 12 White British 2 Black or Black British African 2 Preferred not to say 1 White Gypsy/Traveller 1 Mixed Race 18 Lancaster June 2023 27–60 years 8 White British 8 Dundee March 2024 45–75 years 6 White British 2 White Scottish 1 Scottish 10 started 9 completed Kings Lynn August 2024 15–24 years 6 White British 6 5 Sites 15 months Mean = 41 years 47 participants For the inaugural Change Minds project, (in the North Norfolk area of East Anglia, (6/23N) the project was described as having achieved far greater outputs and benefit to participants than originally anticipated. Participants have described how much they profited from the experience, developing skills and strengths that have endured on which they can draw into their daily lives. This is a shining example of how a non-medical intervention can contribute to real life health gains when people are offered interesting opportunities, coupled with the right support to undertake the first step to improving wellbeing (Dr Hill’s Casebook, 2021: pg. 126). The Change Minds project has run 11 times since 2016, based in 6 different areas of the UK. Venues have included one project being hosted at a local prison, which required considerable adaptations to manage the security requirements of bringing in materials, accessing inmates and unexpected consequences of handling missing equipment (e.g., several fine line pens went missing that required additional personal searches). Table 2 below provides an oversight of the documentary mapping process undertaken, alongside these evidence sources, with the consequences or impact identifiers located alongside the five steps to wellbeing. Table 2 Change Minds data sources, mapped to Five Steps to Well-being outcomes FIVE WAYS TO WELLBEING CHANGE MINDS EVIDENCE SOURCE PARTICIPANT OUTCOME CONSEQUENCES Be Active Participant feedback Project Evaluation sheets Travelling to and from the records offices, taking project field trip and (grave) site visits. Improved confidence to travel on public transport. Reduced cost and use of Taxi’s for travel. Take Notice Dr Hills Case Book, Change Minds website Interviews with Change Mind project leads Observation of peer groups responses/interactions to events during project. Undertaking a creative /artefact piece Key role of the project facilitators, to manage situations as they arise with kindness, safety and adaptability. Peer group support Keep Learning Project Evaluation sheets Interviews with Change Minds leads. Archive research activity Personal histories Archive research, palaeography skills, how to care for/handle archival records, how to write with quills, research skills, working as part of a group, analytical skills Historical case notes facilitated discussions ‘I have learnt how much I enjoy history’ Participant quote 6/23HMP So many new skills have been learnt and re-learned through archive research process and final creative product piece. Give Back Participant evaluations Project Evaluation Sheets Website information Interviews with Change Minds leads Peer Group support so, I was very, very intent on removing the illness and finding the person rather than just showing illness Participant quote 8/23 Stay connected Personal histories, Project Evaluation sheets Participant feedback Project local co-ordinators reflections A lot of care and attention shown towards each other 4/24 Genuine affection for each other was shown 6/23L INSERT Table 2 : Change Minds data sources, mapped to Five Steps to Well-being outcomes Whilst many of these outcome’s blend across the five steps to well-being, each are taken in turn offering direct quotations and facilitator feedback, to provide more detail of the experiences and consequences of engaging with the Change Minds programme. Well-being 1: Be Active . Dropout rates were minimal, as only 1 person in the Dundee group withdrew. During the 12 weeks of the course non-attendance rates varied and were contextually identified as dependant on the venue (i.e., prison restrictions), people’s health challenges, and the distance and time needed to travel to attend sessions in person either at the Record Offices, or on the field trips to workhouse locations for example. However, participants and facilitators also noted the increased amount of time spent doing activities outside of their daily routines. Additional time was being spent getting to venues, which over time added to the overall sense of achievement participants show, in describing their increased confidence in using public transport, plus the enjoyment they were gaining from the project, which all prompted a desire to remain actively engaged as part of the Change Minds group activities. This was except for the Prison venue, where participants were not able to leave the premises. Not only was there reported increases in physical activity, but the participants also reported an increased active imagination, as they explored the historical cases, and started to think also about the carer’s role in someone’s recovery, and how they were to creatively capture their experiences for the final piece. The curated facilitator approach to the project enabled for a sensitive and adaptable approach, acknowledging the age differences, physical as well as mental health issues, that needed to be managed sensitively and on an individual bases. For example, one participant’s eye sight was poor, so adaptations were made for this in how they were able to access and read records and other archive materials. One other participant’s mental health deteriorated during the course, and they were able to be referred promptly back to their mental health service providers, which helped achieve a positive outcome in that the person re-joined the course towards the end, missing only four sessions in total of the twelve. Well-being theme 2: Take Notice. Participants (6/23 MoM) noticed in several aspects of project delivery, an appreciation for the way in which the Project Coordinators were delivering the project. Sessions were set up to feel relaxed, unhurried and offered a supportive learning environment, that enabled people to bond as a group: Participants wrote that ‘ it creates that kind of environment where you do want to be part of it and you do sort of, you know, get as much as you can out of it’ and ‘ excellent facilitation, extremely respectful, kind and considered, very well done’ . The Project Coordinators explained that their approach was intentional, and aimed at achieving openness and being honest, particularly not shying away from answering awkward questions that get asked. This all helped to build a learning environment build on trust. “ One participant that opened about their past struggles with dyslexia and how … things in life have been much harder for them because of that and how people have treated them because of that. They said that this project has pushed them to … try things that they wouldn't have tried before and [they have] realised that they are can-do things they thought they couldn't, but [it’s] also is giving them a place to talk about how this has impacted their life and have people that are really supportive and receptive to what they're saying and back them up.” (Project Coordinator) Well-being theme 3: Keep learning Impact on participants was also varied, ranging from improved confidence to travel using public transport, to learning about the past and how the carers were helping improve people’s lives through basic interventions such as bathing and feeding. “I think one of the main things … there was like almost in a sense of like curating a piece to put on for us to portray a certain message. It’s something I’ve never done before, so making my own thing which was completely different to everybody else’s … … … … My [response], I wanted it to be questions like, you know, I wanted you to question it. So like cueing in a way different to other people to portray a certain message. I thought I honed that skill quite well, especially looking through actual archives, you know material and things and getting a broader understanding and knowing how to do that. Like it’s one thing to know it, but to put it into practice, it’s completely different. And I think I really did learn that skill. ” (Participant) Well-being theme 4: Give back Participants shared their lived experiences and social challenges, recognising that the Change Minds project participants and facilitator became and was curated as a safe space to share ideas, experiences and learning. One participant explained they had Tourette’s but offered with this an explanation to the group in the first week about how best to deal with any swearing, tics or verbal comments they might make that others might find offensive, distracting or disruptive. The group accepted their explanation, and quickly adapted to a renewed understanding of the situation for that person. Another individual opened within the group about issues they had experienced at college, and exclusions, which suggested they too felt that the group structure was a safe place to raise these issues, with a group who would understand, as they too had experienced similar embarrassments, exposure and vulnerabilities. “We had within the group … pretty open conversations both in terms of how people have been treated in the past and … by the medical profession, but also by other people and … the challenges that they face in everyday life and … partly it was just sharing and there weren't any solutions anywhere, but it was also a bit reflective in terms of how the experience and change minds had helped with that.” (Archivist) What helped to achieve this level of openness and safety was reported as a direct consequence of the approach taken by project facilitators, who curated the project space through carefully planned activities and adequate time allocated for reflective group interactions. For example, the way in which sessions were planned allowed an element of choice for participants, giving them a personalised approach and chance to explore aspects under their own fruition/agency, which throughout most of their education, or institutional experiences was often taken away or dictated. Wellbeing theme 5: Stay Connected Remaining connected through a process of peer support was at the core of many aspects of the Change Minds outcomes achieved. As stated in the 4/24 cohort feedback: “The group as a whole when they started were very quiet and shy but came out of their shells as the programme progressed.” (Facilitator) “Seeing the young people develop in confidence. Seeing them engage with the project.” (Facilitator) For example, one participant who had good attendance and was really engaged, had admitted in the first session that they didn’t like history but by the end was really interested and invested in their case study and the wider research around that individual. “I loved every minute of it. The group was great, and we all shared experiences.” (Participant) This increased confidence was also noticed of one participant by two family members who attended the celebration event in the last session: “she has come out of herself” and “she wouldn’t have talked to you before; she would have been in the other room red faced” . Indeed, one of these individuals, in talking about their family member’s increased confidence and ability to chat since taking part in the project, also revealed how the participant had worked with their grandfather to take photos in Kent, showing how Change Minds had helped to support an intergenerational activity outside the project. There was another example of the project leading to work with others outside the project (see below, under the point about skills). “I think this whole project is quite interesting because you’re going back and learning more about specific people and how life would have been for them. Because when you learn about history, you don’t tend to focus on what perhaps people like this would have. You wouldn’t have learned about their point of view. You only tend to learn about more famous people, so more disabled people or people that would have been in lower class parts of society. It’s very interesting to learn about their history.” (Participant) I thought, ‘Oh, God, I didn’t want to write this person’s story if I didn’t know them’ … So, I sort of made like a missing person’s report almost with everything I had. But little questions on like, you know, post it notes to like sort of encourage someone to be like ‘Hmm how do you look into that then?’ Or ‘Oh is this really who he is?’ Because I would hate for someone to write my story if they didn’t know it. And it’s such a delicate subject… So, I didn’t want to, just like, bare all of this like almost like … dirty laundry out almost. And be like this is, you know, petty crime-filled history. And he was quite nasty when he was there for a little while because he was so unwell. And it’s like what? That’s not really him that’s his illness. Yeah and I think that was really important to distinguish that because it’s quite stigmatising and we’ve ‘changed minds’ especially I know that your whole idea is to quite literally ‘change minds’. So I was, and I think … because [of] my mum’s mental health now so and I’ve got a long history of mental health workers in the family or NHS, so I was very, very intent on removing the illness and finding the person rather than just showing his illness. If that made sense. DISCUSSION “Change Minds is about curiosity – if you come to the project you have to be curious, about others, but also about yourself, and people will be curious about you- and in what you are doing”. (Change Minds Lead Interview 1). Curiosity has long been linked to well-being, through for example it’s original influence on the ‘Take Notice’ aspect of the five ways to well-being (Phillips et al, 2005). Curiosity is described as an important characteristic of human progress, with research showing how remaining curious can improve well-being through a desire to continue to learn and discover (Blanco-Donoso et al, 2023 ). Curiosity can be taught not just through encouraging play, with many researchers indicating curiosity is an essential aspect associated with how intellect is developed over time. Curiosity can shape how a person deals with new situations in terms of distress tolerance, coping strategies and anxiety management, all of which leading to how a person navigates situations, seeking to have a satisfying and engaging life (Kashdan et al, 2009 ). From this standpoint, the Change Minds project stimulates curiosity, not just through the experience of entering with the Records office, but also in being taken through a process of learning, in how to undertake archive research and reigniting creativity through expression of that learning and personal choice. Choosing an historic case study, (which the Change Minds project team have already curated, through having scanned case notes to avoid particularly distressing outcomes), allows participants to gaze safely into a person’s life, captured and recorded from times past. This curated case study approach raises aspects of how Change Minds incorporates notions of space and place with well-being. There are ‘ spaces of capability, in which social, physical space may enable or hinder wellbeing through self-fulfilment’ (Fleuret and Atkinson, 2007 ; pp 113). Through use of an out of the ordinary space, as a process of inviting people into Records Offices, participants are immediately being placed in new, unusual, hallowed spaces, designed for a specific purpose, which offers participants access to something outside the ordinary, in turn creating an integrated therapeutic space , where cultural, emotionally and spiritual exploration can take place (Milligan et al, 2004 ). An outcome of the Change Minds project has been to promote curiosity, with an overarching well-being outcome focus, that affects a person’s perception of access, security, conflict, and risk as complex interactions that have consequences on a holistic, socio-ecological model of health and well-being. Curiosity projects, such as Change Minds, do however pose risks. It has been argued that, in its purest form, curiosity is arguably fundamentally risky, since open-ended enquiries can lead anywhere, overturning any stone, uncovering knowledge that may be useful, enlightening, or alternatively invasive and/or dangerous. Risks associated with curiosity were visible to the participants in this project, whose engagement with curiosity-driven projects required them to measure and negotiate or mitigate these risks. …. curiosity can open a can of worms, eliciting stressful personal and collective memories, which are not always palatable for everyone involved. Thus, while we found and argued that it is possible to ‘take notice’ and be curious anywhere, and in ordinary rather than exceptional places, we also found that spaces for curiosity tend to be circumscribed, spatially and temporally ring-fenced, as a way of managing the risks associated with some forms and expressions of curiosity. This is an important finding in practical terms (Phillips et al, 2015 : 2352). Stimulating curiosity within the Change Minds project came with intentioned curation and care, as without that facilitated approach to project curation, participants would have been potentially overwhelmed and scared. The tripartite partnership approach between the Records Office, the Mental health service provider, and the person living with SMI, also provided an infrastructure of collaborative support, placing the person within their place, and space in their local community. Through bringing together the holistic socio-ecological model, of adapting space and place with well-being as a recovery process, the Change Minds project offers a well curated therapeutic space from which to explore mental health living conditions, past and present, through a creative exploration of different perspectives and aspects of what constitutes a wellbeing recovery journey. Lessons learnt 1: Working in a tripartite relationship (between health provider, charity and records office) provides a unique approach to community and locality based improved mental health awareness, literacy and connectedness, addressing social isolation and demystifying mental health care of the past asylum settings 2: A well curated and effectively facilitated programme such as Change Minds has potential to be scaled up across other sites within a country where good records have been kept of asylum care and can be a rich source of evidence from which to address contemporary understanding of living with mental health in modern society. 3: Maximising the wellbeing agenda of the Change Minds project in participants ability to learn new skills, engage in a safe space of exploration, aligned to well facilitated peer support infrastructure can be mapped to achieve outcomes of improved wellbeing over the 12-week period, with potential for longer lasting sustainable impact over time. CONCLUSION The collaborative engagement of different organisations within an integrated care system, working as effective partnerships as the Change Minds project model showcases, offers a dynamic and responsive approach to addressing long standing community disconnections, enabling people on the outskirts of communities to find a place, and a creative space from which to safely explore new connections for their wellbeing. Building space for new relationships and connecting people through the archive research provides a powerful dynamic, as a means for addressing and achieving a level of social cohesion. Change Minds is addressing social isolation, and improving five ways to wellbeing, as other such social connected programmes of this nature have in addressing the issue of loneliness, isolation, and an improved sense of self (Laidlaw et al, 2023 ). The twelves sessions of a curated Change Minds project have been seen to have Increased both participants, and the curators of the project’s knowledge of how to engage with historic texts, to gain a deeper engagement with the subject matter, whilst also addressing aspects of a modern process of caring for those living with a serious mental illness, connecting them to their local community, through an enriched understanding of the past. Participants increased well-being was also traced during the project, and is reported in the evaluation currently still underway, as achieved through new learnings, about how to undertake archive research. New skills were learnt, and new connections made, with the person from the past, but also with their peer group. Care and curation were also seen in how participants held a desire to remain ‘true’ to the individuals being researched, expressing a heartfelt inspiration that even after 100 years had passed, this person was now able to help others explore their unknown contemporary colleague’s own health and well-being. The Change Minds project has offered people the chance to achieve deep reflections, about the causes, care and spaces within which mental health were treated in the past. With similar exclusions, embarrassments and behaviours as those undertaking the archive research have experiences themselves, in the modern day. This connection offered a reassessment of perception of care in the past, with some participants gaining considerable insights to the level of care on offer, the hope, optimism and achievements of those past inmates, inspiring and stimulating their own continued recovery journey, expressed through renewed skills, confidence and ability to enter new spaces with confidence. Having undertaken the 11 location-based projects, the Change Minds Project leads have learned lessons about the need for local adaptations, as venues, personnel and spaces required. As a result, Change Minds offers a promising approach to collaborative partnership working across local government, service providers, and charitable sector, that gives an effective facilitative operational model that offers additional adaptations that can allow for a multi-stakeholder integration approach to understanding living with mental health and addressing the five ways to well-being. When considered as a robust model of holistic, socio-ecological model of health and well-being, consistent potentials to Change Minds on the value of mental well-being can no longer merely be kept hidden and locked away. Declarations Declaration of Interest Laura Drysdale and Gary Tuson were the originators of the Change Minds projects, and invited Sally Hardy to undertake the secondary analysis to achieve the evaluation for purposes of scalability and publication/dissemination. Ethical Approval University of Dundee, School of Humanities and Social Science. Ref SREC22-011 Funding National Heritage Lottery Fund. Ref NM-21-00407 Author Contribution Laura Drysdale and Gary Tuson originated the Change minds project concept, funding application and learning, resource materials. Provided interview data and access to all change minds materials. Critical readers and contributed to writing the article. Sally Hardy undertook interviews, secondary data analysis and primary author Acknowledgement All data is available via the restoration trust and can be found through contacting the corresponding author, or via the website at www.changeminds.org Data Availability All data is available via the Restoration trust, and can be accessed via making contact on the Change Minds website www.changeminds.org References Aked J, Marks N, Cordon C, Thompson S. (2008). Five Ways to Wellbeing: A Report Presented to the Foresight Project on Communicating the Evidence Base for Improving People’s Well-Being . London: New Economics Foundation. Berrios G, Porter R. (2019) A history of clinical psychiatry: the origin and history of psychiatric disorders. London Althone. Blanco-Donoso LM, Hodzic S, Garrosa E, Carmona-Cobo I, Kubicek B. (2023). Work Intensification and Its Effects on Mental Health: The Role of Workplace Curiosity. Journal of Psychology. 157(7):423-450. doi: 10.1080/00223980.2023.2235069 Change Minds Project Website: https://changeminds.org.uk (last accessed 5/4/2024) Connell, J. P., & Kubisch, A. C. (1998). Applying a theory of change approach to the evaluation of comprehensive community initiatives: progress, prospects, and problems. New approaches to evaluating community initiatives , 2 (15-44), 1-16. Daniels K, Watson D, Nayani R, Tregaskis O, Hogg M, Etuknwa A, Semkina A. (2021). Implementing practices focused on workplace health and psychological wellbeing: A systematic review. Social Science & Medicine . May 1;277:113888. doi.org/10.1016/j.socscimed.2021.113888 Dr Hills’ Casebook (2021). The Anthology . The Restoration Trust. Available via : https://restorationtrust.org.uk/dr-hills-casebook-2/ (last accessed 15 July 2024). Farrier A, Dooris M, Froggett L. (2019). Five Ways to Wellbeing: holistic narratives of public health programme participants. Global Health Promotion . 26(3):71-79. doi:10.1177/1757975917732352 Fleuret S, Atkinson S. (2007). Wellbeing, health and geography: A critical review and research agenda. New Zealand Geographer. Aug;63(2):106-18. Foster, A., Thompson, J., Holding, E., Ariss, S., Mukuria, C., Jacques, R., Akparido, R. and Haywood, A., (2021). Impact of social prescribing to address loneliness: a mixed methods evaluation of a national social prescribing programme. Health & Social Care in the Community , 29 (5), pp.1439-1449. DOI: 10.1111/hsc.13200 Foucault M. (1971) Orders of discourse. Social science information . Apr;10(2):7-30. Goffman E. (1961). Asylums: Essays on the social situation of mental patients and other inmates. AldineTransaction. Government Office for Science. (2008). Foresight mental capital and wellbeing project. Final project report. London: Government Office for Science : https://www.gov.uk/government/publications/five-ways-to-mental-wellbeing (last accessed 7th June, 2024) Hakim, C. (1982) Secondary analysis in social research. A guide to data sources and method examples. London UK George Allen and Unwin. Human Rights Act (1998) available via : https://www.legislation.gov.uk/ukpga/1998/42/contents (last accessed 7th June, 2024). Kashdan, T. B., Gallagher, M. W., Silvia, P. J., Winterstein, B. P., Breen, W. E., Terhar, D., & Steger, M. F. (2009). The curiosity and exploration inventory-II: Development, factor structure, and psychometrics. Journal of research in personality , 43 (6), 987-998. doi: 10.1016/j.jrp.2009.04.011 Killaspy H, Harvey C, Brasier C, Brophy L, Ennals P, Fletcher J, Hamilton B. (2022) Community‐based social interventions for people with severe mental illness: a systematic review and narrative synthesis of recent evidence . World Psychiatry . Feb;21(1):96-123. https://doi.org/10.1002/wps.20940 Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. (2024) The social determinants of mental health and disorder: evidence, prevention and recommendations. World psychiatry . Feb;23(1):58. doi: 10.1002/wps.21160 Laidlaw, R. J., McGrath, R., Adams, C., Kumar, S., & Murray, C. M. (2023). Improved Mental Health, Social Connections and Sense of Self: A Mixed Methods Systematic Review Exploring the Impact and Experience of Community Reminiscence Programs. Journal of Multidisciplinary Healthcare , 16 , 4111–4132. https://doi.org/10.2147/JMDH.S438730 Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. (2020). Health Equity in England: The Marmot Review 10 Years On. Institute of Health Equity. (health.org.uk/publications/reports/the-marmot-review-10-years- on). Milligan C, Gatrell A, Bingley A. (2004). ‘Cultivating health’: therapeutic landscapes and older people in northern England. Social science & medicine . May 1;58(9):1781-93. National Lottery Heritage Fund Website: https://www.heritagefund.org.uk (last accessed 29/4/2024) NHS England, “Social prescribing,” https://www.england.nhs.uk/personalisedcare/social-prescribing/ (last accessed 7 June 2024). Phillips, R., Evans, B., & Muirhead, S. (2015). Curiosity, place and wellbeing: Encouraging place-specific curiosity as a ‘way to wellbeing’. Environment and Planning A , 47 (11), 2339-2354. doi.org/10.1177/0308518X15599290 Porter R. (1987a). Mind-forg'd manacles: A history of madness in England from the Restoration to the Regency. Harvard University Press. Porter, R. (1987b). Madness and society in England: The historiography reconsidered. Studies in history , 3 (2), pp.275-290. Rawcliffe C. (1999) Medicine for the soul: The medieval English hospital and the quest for spiritual health. Religion, health and suffering . 316-38. Robinson, P., Turk, D., Jilka, S., & Cella, M. (2019). Measuring attitudes towards mental health using social media: investigating stigma and trivialisation. Social psychiatry and psychiatric epidemiology , 54 , 51-58. Ryan RM, and Deci EL. (2001). On happiness and human potentials: a review of research on hedonic and eudaimonic well-being. Annu Rev Psychol . 52: 141–166. Showalter E. (1985). The female malady: Women, madness, and English culture , 1830-1980. Virago Press. London. Szasz TS. (1960). The myth of mental illness . American psychologist. Feb;15(2):113. World Health Organization. Mental health action plan 2013–2020. 2013. [Cited 1 April 2014.] Available from URL: http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf. www.legislation.gov.uk/ukpga/1998/42/contents (last accessed 29/4/2024) Footnotes Change Minds Project Website: https://changeminds.org.uk (last accessed 5/4/2024) National Lottery Heritage Fund Website: https://www.heritagefund.org.uk (last accessed 29/4/2024) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4730707","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":334480914,"identity":"a17dc8d5-7203-4e84-ae86-645fd90f2648","order_by":0,"name":"Sally Hardy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYFACHiBmY5CD8yWI1WJMupbEBqK1yDfwHvxcUXY4fcPx5gcMP2oYEmc2ENBicIAvWfLMucO5G84cM2DsOcaQOJuQLQYMPAaSjW1ALTcSDBh4GxgS5xF2GI/xT6CWdIP7zz8w/iVGC8MBHjOQLQkGN3gMmEG2EHbYYR4zy4Zz6YYzz+QUHJY5JmFM0Pvy7T3GNxvKrOX5jh/f+PBNjY3sjAOErGEGk80QRxIVkVBQR7TKUTAKRsEoGIEAAKBePyX+zXngAAAAAElFTkSuQmCC","orcid":"","institution":"University of East Anglia","correspondingAuthor":true,"prefix":"","firstName":"Sally","middleName":"","lastName":"Hardy","suffix":""},{"id":334480916,"identity":"c407c3e8-34ad-4ac2-ae44-7339da38f118","order_by":1,"name":"Laura Drysdale","email":"","orcid":"","institution":"Restoration Trust","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Drysdale","suffix":""},{"id":334480918,"identity":"1c66ca9f-0cec-428c-8b85-57e93b0058ed","order_by":2,"name":"Gary Tuson","email":"","orcid":"","institution":"Norfolk Records Office","correspondingAuthor":false,"prefix":"","firstName":"Gary","middleName":"","lastName":"Tuson","suffix":""}],"badges":[],"createdAt":"2024-07-12 13:44:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4730707/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4730707/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102747677,"identity":"b2d8f19d-938f-4f00-872f-4853e1d017e8","added_by":"auto","created_at":"2026-02-16 09:05:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":587973,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4730707/v1/f70f512f-f820-49d7-95fe-0f4ca5b2e573.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePartnering Curiosity with Creative Connections Through the Change Minds Project : An Integrated Commununity Case Study\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePeople living with severe mental ill health remain one of the most marginalised groups in society (Killaspy et al, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Social factors inherent in mental health prevalence are an important aspect of both mental health prevention and searching for improvements to treatment options to address a growing global burden of mental health problems (WHO,2023). Yet, progress over the last decade of research has tended to centre on improved understanding of neuroscience and neurobiology, whilst investigating the psycho-social factors of mental health issues has lagged in comparison (Kirkbride et al, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTraces of the past can be seen in how mental health and concepts of \u0026lsquo;madness\u0026rsquo; are understood and treated within and across global society today. Madness, when considered a prolonged or acute period of mental ill health, has long been an area of curiosity, fascination, fear, myth and legend. There is a significant point in understanding historical concepts of mental illness, when describing this as an \u0026lsquo;embarrassment of riches\u0026rsquo; (Berrios and Porter, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e: Preface); as where different interpretations and perspectives continue to bring academics and clinicians together, searching to achieve new insights and information from which to continue to seek to help those who remain poorly understood.\u003c/p\u003e \u003cp\u003eHistorical fascination to seek a cure for mental health has led many societies to see the person as possessed by an external force, in turn leading to thoughts of a spiritual demonisation as explanation for any signs of oddity. In association treatments were sought from religious priests, shaman or through physical bloodletting, beatings and other forms of public humiliation (Showalter, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1985\u003c/span\u003e; Porter, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1987a\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e1987b\u003c/span\u003e; Szasz, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1960\u003c/span\u003e; Goffman, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1961\u003c/span\u003e). In the medieval period, mental disturbances were believed to be influenced by astrological changes, with astrology remaining a part of a physicians\u0026rsquo; classical training until the 18th century (Rawcliffe, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e1999\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMental ill health remains a social and politically contentious issue. Historical concepts of madness remain linked to the current, or most dominant conceptual system at any given time in society, whereas from a social historian viewpoint society\u0026rsquo;s understanding and treatment of mental ill health has not altered much since the period of enlightenment, which stressed notions of reason and rationality (Foucault, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1971\u003c/span\u003e; Porter, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e1987a\u003c/span\u003e/b). In the United Kingdom the Parliamentary Human Rights Act (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1998\u003c/span\u003e) expressly identified freedom from inhumane acts or degradation, which has helped promote inclusive strategies for how individuals are being treated within society. Social media has brought a level of exposure and increased awareness of mental health issues, which has been linked with people\u0026rsquo;s willingness to speak more openly about their own mental wellbeing, both in the workplace and in public (Robinson, et al \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e;Daniels et al, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSir Michael Marmot\u0026rsquo;s (Marmot et al, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) report shows little progress has been made in addressing social determinants of ill health, where poverty, housing, and geographical locality all have potential negative impact on a person\u0026rsquo;s life chances and health related longevity. Therefore, improving someone\u0026rsquo;s health not only extends their life years, but it can also ultimately improve their long-term chances of modifying social risk factors. Some would argue, good mental health is synonymous to social justice. Using a social justice approach to addressing mental wellbeing is an under researched area. Yet, addressing health inequalities, through good integrated care strategies, where partners are working in close collaboration to utilise resources, expertise and local assets, has become a favoured approach to contemporary health and social care integration.\u003c/p\u003e \u003cp\u003eSocial prescribing in the UK (NHS England, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) has contributed to the notion of seeking community driven support, helping those living outside of hospital and other institutional settings to integrate, through linking them more closely with what support systems are available locally. Social prescribing has offered one of the most significant shifts in care provision over the last decade, bringing a new form of connection for people across their community, yet issues of how social prescribing helps people with severe mental ill health has proven to be limited, apart from providing connections to services outside of statutory care organisations, with some identified improvement in addressing aspects of loneliness (Foster et al, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince July 2022, England has introduced Integrated Care system architecture, from which to engage in innovative new ways of providing care packages for people, based within their location, community and social contexts. Through utilising this case study approach to monitor impact potential of community driven innovation, the Change Minds project offers one such model where local innovation has offered new partnerships, (across health, local government, and charitable agencies), to achieve health and wellbeing improvements to people who remain on the periphery of a traditional acute based service provision model. Working this way, as a facilitated approach to integrated service advancements, the Change Minds project offers a social emancipatory approach to addressing long term connected communities, that is being evaluated for scaling up. Yet, there is confusion when seeking to measure outcomes of social interventions, particularly when these are peer-led, or co-led interventions for people living with mental health issues (Killaspy et al, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Social outcomes associated with these socially based interventions are inherently difficult to measure, due to variability and therefore pose challenges to verifying outcomes at scale. Achievement locally have been identified, when taking an integrated care approach, in seeking to identify an evidence based, culturally sensitive and sustainable universal programme of care that can enhance a person\u0026rsquo;s wellbeing, through improving their skills and confidence to live well within their local communities and connecting them with their local services to further enable their own strategies for coping well with their health condition and are gaining attention for scalability. This paper offers a case study review of a novel tripartite partnership approach for people living with a diagnosis of serious mental illness, seeking to offer a locally driven place-based model that can be adapted to other localities through effective integrated partnerships.\u003c/p\u003e \u003cp\u003e Greater cross sector collaboration to achieve inclusive outcomes has been at the core of this project, in line with the integrated care approach to health and social care. Through reporting on activity to date, it is intended that others might be interested to utilise this as a partnership model for engaging across different local resources more effectively, through the Change Minds project format.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis paper evaluates the Change Minds project\u003csup\u003e1\u003c/sup\u003e, as an innovative partnership approach that links heritage archive records with mental health service providers and is offered to people living with serious mental illness to support their well-being recovery. It is a unique project that incorporates exploring personal case records of asylum inmates, from 18-19th century, as a curated method of social engagement for those living with mental health conditions, through learning lessons from the past, connecting these to today\u0026rsquo;s experiences of well-being.\u003c/p\u003e \u003cp\u003eChange Minds is a National Lottery Heritage\u003csup\u003e2\u003c/sup\u003e funded project that offers access to a central resource hub hosted by a partnership between the Restoration Trust and the Norfolk Record Office. Trialled through several iterations achieving the final 12-workshop programme, five location sites are the source of evidence for this case review. The Change Minds Hub offers the main resource for accessing all project materials needed to achieve a well curated process of archive research, peer learning and social connection as real cases of asylum care from the past are transported into contemporary creative expressions. The hub provides training manuals, project branding, recruitment leaflets, an established evaluation approach, and even provide some petty cash to make the delivery of Change Minds as efficient and effective as possible when starting up in new locations.\u003c/p\u003e \u003cp\u003eThe Change Minds project has taken place at 11 different sites across the UK, with multiple forms of evaluation underway at each site, using both informal and formal means of capturing activity and outcomes. Each of these elements of activity have been used for capturing data from which to map indicators of success against the Five Ways to Wellbeing (Government Office for Science, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003ewas obtained, before offering participants and stakeholders voluntary status to take part in the evaluation, with an open invitation to undertake survey data, and personal interviews with assurance their engagement in the evaluation would not impact their ability to take part in the Change Minds project. Access to the Change Minds project learning and ethical consent related resources are accessible to other interested settings, such as schools, colleges, forensic settings, military veterans and University students. An objective thorough evaluation is nearing completion, whereas this paper captures five of the early site delivery data.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eWell-being is frequently identified as how an individual seeks to achieve their physical, mental and psycho-social aspects of self, through where and how they seek and sustain pleasure and happiness in life, avoid pain and therefore achieving human flourishing or thriving in life, as opposed to merely surviving in the modern world (Ryan and Deci, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Farrier et al, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Well-being offers a useful approach to understanding a holistic and personalised benchmark, from which to understand health status, as opposed to more traditional medically focused measures of health and illness (Aked et al, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eFive ways to well-being\u003c/h2\u003e \u003cp\u003eThe five ways to wellbeing are reported to be a flexible framework that allows its application across multiple diverse project participant groups (Farrier et al, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe five ways to well-being are based around the principle of \u003cem\u003efeeling good and functioning well\u003c/em\u003e (20). There are five associated recommendations for people to engage with that promotes their individual well-being. These are:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eBe Active\u003c/em\u003e \u0026ndash; increasing or ensuring there is physical activity each day, with recommendations of at least 20 mins walking per day to reduce risk of heart disease, for example\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eTake Notice\u003c/em\u003e \u0026ndash; building upon notions from Eastern philosophy\u0026rsquo;s mindfulness, this aspiration encourages a person to take time to notice the world around them, and to reflect on daily experiences, appreciating the here and now, rather than worrying about the future\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eKeep Learning\u003c/em\u003e \u0026ndash; through remaining curious, to understand more of the world, and building confidence through remaining open to learning new things\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eGive back\u003c/em\u003e \u0026ndash; providing the chance to feed forward and give back build\u0026rsquo;s confidence and a sense of pride in contributing to either the local community, one\u0026rsquo;s family and friends. Often seen as encouraging people to take a first step in volunteering, as a person rebuilds their life after a period of ill health.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eStay Connected\u003c/em\u003e \u0026ndash; keeping in touch with a social circle, trying to make connections within a social network, is shown to increase a person\u0026rsquo;s sense of purpose and address loneliness and risk of social isolation.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eMapping the Change Minds\u0026rsquo; documentary evidence to the five steps to well-being, offers an initial theory of change (Connell and Kubisch, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1998\u003c/span\u003e) to capture the inputs, outputs and consequences of the project format, offering an integrated, place-based approach to supporting people living with long term serious mental health, within their local context, linking them to the historical past notions of asylum.\u003c/p\u003e \u003cp\u003eThis case study evaluation reviewed seven main documentary data sources as a secondary data analysis approach (Hakim, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1982\u003c/span\u003e). These included 3 interviews with the Change Minds Project leads, assorted documentary evidence including information contained within a project outcome known as \u0026lsquo;Dr Hills Case Book\u0026rsquo;, (2021) exploring information available via the Change Minds Website, and access to 5 project evaluation reports from external partners undertaking a funded evaluation of Change Minds as part of the funding received via the National Heritage Lottery fund (achieved in 2022).\u003c/p\u003e \u003cp\u003eWritten project evaluations were reviewed from the Change Minds project evaluation team, delivered at the Museum of the Mind South London delivery (6/23MoM), Norwich Prison (6/23HMP), then at Lancaster (6/23L), Dundee (4/24), and at Kings Lynn (8/24).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe age range of Change Minds participants varied from 15 through to 76 years (average age\u0026thinsp;=\u0026thinsp;41). Each cohort size varied from 5 participants, through to a maximum of 18. Ensuring the participant cohorts remain manageable, for attending the Research office space, and to encourage the peer support elements of working closely with a consistent group over the 12 sessions of the project period. Below is a table that captures demographic data of participants who self-reported through use of project written feedback sheets made available for this case study review process. Prior to this Change Minds project was trialled at two sites during 2015/16, then again in 2018/19. The scaling up approach is what has been captured in the table below at five sites during 2022\u0026ndash;2024.\u003c/p\u003e \u003cp\u003eInsert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Change Minds participants\u0026rsquo; demographic data recorded at five delivery sites.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChange Minds participants\u0026rsquo; demographic data recorded at five delivery sites.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipant Age Range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuseum of the Mind South London\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJune 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u0026ndash;72 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 White British\u003c/p\u003e \u003cp\u003e1 Preferred not to say\u003c/p\u003e \u003cp\u003e1 Asian/British/Indian\u003c/p\u003e \u003cp\u003e1 Mixed Jewish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHM Prison Norwich\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJune 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u0026ndash;53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 White British\u003c/p\u003e \u003cp\u003e2 Black or Black British African\u003c/p\u003e \u003cp\u003e2 Preferred not to say\u003c/p\u003e \u003cp\u003e1 White Gypsy/Traveller\u003c/p\u003e \u003cp\u003e1 Mixed Race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLancaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJune 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u0026ndash;60 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 White British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDundee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarch 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u0026ndash;75 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 White British\u003c/p\u003e \u003cp\u003e2 White Scottish\u003c/p\u003e \u003cp\u003e1 Scottish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 started\u003c/p\u003e \u003cp\u003e9 completed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKings Lynn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAugust 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u0026ndash;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 White British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 Sites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;=\u0026thinsp;41 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 participants\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor the inaugural Change Minds project, (in the North Norfolk area of East Anglia, (6/23N) the project was described as having achieved far greater outputs and benefit to participants than originally anticipated.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eParticipants have described how much they profited from the experience, developing skills and strengths that have endured on which they can draw into their daily lives. This is a shining example of how a non-medical intervention can contribute to real life health gains when people are offered interesting opportunities, coupled with the right support to undertake the first step to improving wellbeing\u003c/em\u003e (Dr Hill\u0026rsquo;s Casebook, 2021: pg. 126).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe Change Minds project has run 11 times since 2016, based in 6 different areas of the UK. Venues have included one project being hosted at a local prison, which required considerable adaptations to manage the security requirements of bringing in materials, accessing inmates and unexpected consequences of handling missing equipment (e.g., several fine line pens went missing that required additional personal searches).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below provides an oversight of the documentary mapping process undertaken, alongside these evidence sources, with the consequences or impact identifiers located alongside the five steps to wellbeing.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChange Minds data sources, mapped to Five Steps to Well-being outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFIVE WAYS TO WELLBEING\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCHANGE MINDS EVIDENCE SOURCE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePARTICIPANT OUTCOME\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCONSEQUENCES\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBe Active\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipant feedback\u003c/p\u003e \u003cp\u003eProject Evaluation sheets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTravelling to and from the records offices, taking project field trip and (grave) site visits.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImproved confidence to travel on public transport.\u003c/p\u003e \u003cp\u003eReduced cost and use of Taxi\u0026rsquo;s for travel.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTake Notice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDr Hills Case Book,\u003c/p\u003e \u003cp\u003eChange Minds website\u003c/p\u003e \u003cp\u003eInterviews with Change Mind project leads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObservation of peer groups responses/interactions to events during project.\u003c/p\u003e \u003cp\u003eUndertaking a creative /artefact piece\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKey role of the project facilitators, to manage situations as they arise with kindness, safety and adaptability.\u003c/p\u003e \u003cp\u003ePeer group support\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKeep Learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProject Evaluation sheets\u003c/p\u003e \u003cp\u003eInterviews with Change Minds leads.\u003c/p\u003e \u003cp\u003eArchive research activity\u003c/p\u003e \u003cp\u003ePersonal histories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArchive research,\u003c/p\u003e \u003cp\u003epalaeography skills, how to care for/handle archival records, how to write with quills, research skills, working as part of a group, analytical skills\u003c/p\u003e \u003cp\u003eHistorical case notes facilitated discussions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e\u0026lsquo;I have learnt how much I enjoy history\u0026rsquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eParticipant quote 6/23HMP\u003c/p\u003e \u003cp\u003eSo many new skills have been learnt and re-learned through archive research process and final creative product piece.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGive Back\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipant evaluations\u003c/p\u003e \u003cp\u003eProject Evaluation Sheets\u003c/p\u003e \u003cp\u003eWebsite information\u003c/p\u003e \u003cp\u003eInterviews with\u003c/p\u003e \u003cp\u003eChange Minds leads\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePeer Group support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eso, I was very, very intent on removing the illness and finding the person rather than just showing illness\u003c/em\u003e Participant quote 8/23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStay connected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal histories,\u003c/p\u003e \u003cp\u003eProject Evaluation sheets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipant feedback\u003c/p\u003e \u003cp\u003eProject local co-ordinators reflections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA lot of care and attention shown towards each other 4/24\u003c/p\u003e \u003cp\u003eGenuine affection for each other was shown\u003c/p\u003e \u003cp\u003e6/23L\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eINSERT Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: Change Minds data sources, mapped to Five Steps to Well-being outcomes\u003c/p\u003e \u003cp\u003eWhilst many of these outcome\u0026rsquo;s blend across the five steps to well-being, each are taken in turn offering direct quotations and facilitator feedback, to provide more detail of the experiences and consequences of engaging with the Change Minds programme.\u003c/p\u003e \u003cp\u003e \u003cb\u003eWell-being 1: Be Active\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eDropout rates were minimal, as only 1 person in the Dundee group withdrew. During the 12 weeks of the course non-attendance rates varied and were contextually identified as dependant on the venue (i.e., prison restrictions), people\u0026rsquo;s health challenges, and the distance and time needed to travel to attend sessions in person either at the Record Offices, or on the field trips to workhouse locations for example. However, participants and facilitators also noted the increased amount of time spent doing activities outside of their daily routines. Additional time was being spent getting to venues, which over time added to the overall sense of achievement participants show, in describing their increased confidence in using public transport, plus the enjoyment they were gaining from the project, which all prompted a desire to remain actively engaged as part of the Change Minds group activities. This was except for the Prison venue, where participants were not able to leave the premises. Not only was there reported increases in physical activity, but the participants also reported an increased active imagination, as they explored the historical cases, and started to think also about the carer\u0026rsquo;s role in someone\u0026rsquo;s recovery, and how they were to creatively capture their experiences for the final piece.\u003c/p\u003e \u003cp\u003eThe curated facilitator approach to the project enabled for a sensitive and adaptable approach, acknowledging the age differences, physical as well as mental health issues, that needed to be managed sensitively and on an individual bases. For example, one participant\u0026rsquo;s eye sight was poor, so adaptations were made for this in how they were able to access and read records and other archive materials. One other participant\u0026rsquo;s mental health deteriorated during the course, and they were able to be referred promptly back to their mental health service providers, which helped achieve a positive outcome in that the person re-joined the course towards the end, missing only four sessions in total of the twelve.\u003c/p\u003e \u003cp\u003e \u003cb\u003eWell-being theme 2: Take Notice.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants (6/23 MoM) noticed in several aspects of project delivery, an appreciation for the way in which the Project Coordinators were delivering the project. Sessions were set up to feel relaxed, unhurried and offered a supportive learning environment, that enabled people to bond as a group: Participants wrote that \u0026lsquo;\u003cem\u003eit creates that kind of environment where you do want to be part of it and you do sort of, you know, get as much as you can out of it\u0026rsquo;\u003c/em\u003e and \u0026lsquo;\u003cem\u003eexcellent facilitation, extremely respectful, kind and considered, very well done\u0026rsquo;\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eThe Project Coordinators explained that their approach was intentional, and aimed at achieving openness and being honest, particularly not shying away from answering awkward questions that get asked. This all helped to build a learning environment build on trust.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eOne participant that opened about their past struggles with dyslexia and how \u0026hellip; things in life have been much harder for them because of that and how people have treated them because of that. They said that this project has pushed them to \u0026hellip; try things that they wouldn't have tried before and [they have] realised that they are can-do things they thought they couldn't, but [it\u0026rsquo;s] also is giving them a place to talk about how this has impacted their life and have people that are really supportive and receptive to what they're saying and back them up.\u0026rdquo;\u003c/em\u003e (Project Coordinator)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eWell-being theme 3: Keep learning\u003c/h2\u003e \u003cp\u003eImpact on participants was also varied, ranging from improved confidence to travel using public transport, to learning about the past and how the carers were helping improve people\u0026rsquo;s lives through basic interventions such as bathing and feeding.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I think one of the main things \u0026hellip; there was like almost in a sense of like curating a piece to put on for us to portray a certain message. It\u0026rsquo;s something I\u0026rsquo;ve never done before, so making my own thing which was completely different to everybody else\u0026rsquo;s \u0026hellip; \u0026hellip; \u0026hellip; \u0026hellip; My [response], I wanted it to be questions like, you know, I wanted you to question it. So like cueing in a way different to other people to portray a certain message. I thought I honed that skill quite well, especially looking through actual archives, you know material and things and getting a broader understanding and knowing how to do that. Like it\u0026rsquo;s one thing to know it, but to put it into practice, it\u0026rsquo;s completely different. And I think I really did learn that skill. \u0026rdquo;\u003c/em\u003e (Participant)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eWell-being theme 4: Give back\u003c/h2\u003e \u003cp\u003eParticipants shared their lived experiences and social challenges, recognising that the Change Minds project participants and facilitator became and was curated as a safe space to share ideas, experiences and learning. One participant explained they had Tourette\u0026rsquo;s but offered with this an explanation to the group in the first week about how best to deal with any swearing, tics or verbal comments they might make that others might find offensive, distracting or disruptive. The group accepted their explanation, and quickly adapted to a renewed understanding of the situation for that person. Another individual opened within the group about issues they had experienced at college, and exclusions, which suggested they too felt that the group structure was a safe place to raise these issues, with a group who would understand, as they too had experienced similar embarrassments, exposure and vulnerabilities.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We had within the group \u0026hellip; pretty open conversations both in terms of how people have been treated in the past and \u0026hellip; by the medical profession, but also by other people and \u0026hellip; the challenges that they face in everyday life and \u0026hellip; partly it was just sharing and there weren't any solutions anywhere, but it was also a bit reflective in terms of how the experience and change minds had helped with that.\u0026rdquo;\u003c/em\u003e (Archivist)\u003c/p\u003e \u003cp\u003eWhat helped to achieve this level of openness and safety was reported as a direct consequence of the approach taken by project facilitators, who curated the project space through carefully planned activities and adequate time allocated for reflective group interactions. For example, the way in which sessions were planned allowed an element of choice for participants, giving them a personalised approach and chance to explore aspects under their own fruition/agency, which throughout most of their education, or institutional experiences was often taken away or dictated.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eWellbeing theme 5: Stay Connected\u003c/h2\u003e \u003cp\u003eRemaining connected through a process of peer support was at the core of many aspects of the Change Minds outcomes achieved. As stated in the 4/24 cohort feedback:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The group as a whole when they started were very quiet and shy but came out of their shells as the programme progressed.\u0026rdquo;\u003c/em\u003e (Facilitator)\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Seeing the young people develop in confidence. Seeing them engage with the project.\u0026rdquo;\u003c/em\u003e (Facilitator)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFor example, one participant who had good attendance and was really engaged, had admitted in the first session that they didn\u0026rsquo;t like history but by the end was really interested and invested in their case study and the wider research around that individual.\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I loved every minute of it. The group was great, and we all shared experiences.\u0026rdquo;\u003c/em\u003e (Participant)\u003c/p\u003e \u003cp\u003eThis increased confidence was also noticed of one participant by two family members who attended the celebration event in the last session: \u003cem\u003e\u0026ldquo;she has come out of herself\u0026rdquo;\u003c/em\u003e and \u003cem\u003e\u0026ldquo;she wouldn\u0026rsquo;t have talked to you before; she would have been in the other room red faced\u0026rdquo;\u003c/em\u003e. Indeed, one of these individuals, in talking about their family member\u0026rsquo;s increased confidence and ability to chat since taking part in the project, also revealed how the participant had worked with their grandfather to take photos in Kent, showing how Change Minds had helped to support an intergenerational activity outside the project. There was another example of the project leading to work with others outside the project (see below, under the point about skills).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think this whole project is quite interesting because you\u0026rsquo;re going back and learning more about specific people and how life would have been for them. Because when you learn about history, you don\u0026rsquo;t tend to focus on what perhaps people like this would have. You wouldn\u0026rsquo;t have learned about their point of view. You only tend to learn about more famous people, so more disabled people or people that would have been in lower class parts of society. It\u0026rsquo;s very interesting to learn about their history.\u0026rdquo; (Participant)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eI thought, \u0026lsquo;Oh, God, I didn\u0026rsquo;t want to write this person\u0026rsquo;s story if I didn\u0026rsquo;t know them\u0026rsquo; \u0026hellip; So, I sort of made like a missing person\u0026rsquo;s report almost with everything I had. But little questions on like, you know, post it notes to like sort of encourage someone to be like \u0026lsquo;Hmm how do you look into that then?\u0026rsquo; Or \u0026lsquo;Oh is this really who he is?\u0026rsquo; Because I would hate for someone to write my story if they didn\u0026rsquo;t know it. And it\u0026rsquo;s such a delicate subject\u0026hellip; So, I didn\u0026rsquo;t want to, just like, bare all of this like almost like \u0026hellip; dirty laundry out almost. And be like this is, you know, petty crime-filled history. And he was quite nasty when he was there for a little while because he was so unwell. And it\u0026rsquo;s like what? That\u0026rsquo;s not really him that\u0026rsquo;s his illness. Yeah and I think that was really important to distinguish that because it\u0026rsquo;s quite stigmatising and we\u0026rsquo;ve \u0026lsquo;changed minds\u0026rsquo; especially I know that your whole idea is to quite literally \u0026lsquo;change minds\u0026rsquo;. So I was, and I think \u0026hellip; because [of] my mum\u0026rsquo;s mental health now so and I\u0026rsquo;ve got a long history of mental health workers in the family or NHS, so I was very, very intent on removing the illness and finding the person rather than just showing his illness. If that made sense.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Change Minds is about curiosity \u0026ndash; if you come to the project you have to be curious, about others, but also about yourself, and people will be curious about you- and in what you are doing\u0026rdquo;.\u003c/em\u003e (Change Minds Lead Interview 1).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eCuriosity has long been linked to well-being, through for example it\u0026rsquo;s original influence on the \u0026lsquo;Take Notice\u0026rsquo; aspect of the five ways to well-being (Phillips et al, 2005). Curiosity is described as an important characteristic of human progress, with research showing how remaining curious can improve well-being through a desire to continue to learn and discover (Blanco-Donoso et al, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Curiosity can be taught not just through encouraging play, with many researchers indicating curiosity is an essential aspect associated with how intellect is developed over time. Curiosity can shape how a person deals with new situations in terms of distress tolerance, coping strategies and anxiety management, all of which leading to how a person navigates situations, seeking to have a satisfying and engaging life (Kashdan et al, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom this standpoint, the Change Minds project stimulates curiosity, not just through the experience of entering with the Records office, but also in being taken through a process of learning, in how to undertake archive research and reigniting creativity through expression of that learning and personal choice. Choosing an historic case study, (which the Change Minds project team have already curated, through having scanned case notes to avoid particularly distressing outcomes), allows participants to gaze safely into a person\u0026rsquo;s life, captured and recorded from times past. This curated case study approach raises aspects of how Change Minds incorporates notions of space and place with well-being. There are \u0026lsquo;\u003cem\u003espaces of capability, in which social, physical space may enable or hinder wellbeing through self-fulfilment\u0026rsquo;\u003c/em\u003e (Fleuret and Atkinson, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; pp 113). Through use of an out of the ordinary space, as a process of inviting people into Records Offices, participants are immediately being placed in new, unusual, hallowed spaces, designed for a specific purpose, which offers participants access to something outside the ordinary, in turn creating an integrated \u003cem\u003etherapeutic space\u003c/em\u003e, where cultural, emotionally and spiritual exploration can take place (Milligan et al, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). An outcome of the Change Minds project has been to promote curiosity, with an overarching well-being outcome focus, that affects a person\u0026rsquo;s perception of access, security, conflict, and risk as complex interactions that have consequences on a holistic, socio-ecological model of health and well-being.\u003c/p\u003e \u003cp\u003eCuriosity projects, such as Change Minds, do however pose risks.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIt has been argued that, in its purest form, curiosity is arguably fundamentally risky, since open-ended enquiries can lead anywhere, overturning any stone, uncovering knowledge that may be useful, enlightening, or alternatively invasive and/or dangerous. Risks associated with curiosity were visible to the participants in this project, whose engagement with curiosity-driven projects required them to measure and negotiate or mitigate these risks. \u0026hellip;. curiosity can open a can of worms, eliciting stressful personal and collective memories, which are not always palatable for everyone involved. Thus, while we found and argued that it is possible to \u0026lsquo;take notice\u0026rsquo; and be curious anywhere, and in ordinary rather than exceptional places, we also found that spaces for curiosity tend to be circumscribed, spatially and temporally ring-fenced, as a way of managing the risks associated with some forms and expressions of curiosity. This is an important finding in practical terms\u003c/em\u003e (Phillips et al, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2015\u003c/span\u003e: 2352).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eStimulating curiosity within the Change Minds project came with intentioned curation and care, as without that facilitated approach to project curation, participants would have been potentially overwhelmed and scared. The tripartite partnership approach between the Records Office, the Mental health service provider, and the person living with SMI, also provided an infrastructure of collaborative support, placing the person within their place, and space in their local community. Through bringing together the holistic socio-ecological model, of adapting space and place with well-being as a recovery process, the Change Minds project offers a well curated therapeutic space from which to explore mental health living conditions, past and present, through a creative exploration of different perspectives and aspects of what constitutes a wellbeing recovery journey.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLessons learnt\u003c/h2\u003e \u003cp\u003e1: Working in a tripartite relationship (between health provider, charity and records office) provides a unique approach to community and locality based improved mental health awareness, literacy and connectedness, addressing social isolation and demystifying mental health care of the past asylum settings\u003c/p\u003e \u003cp\u003e2: A well curated and effectively facilitated programme such as Change Minds has potential to be scaled up across other sites within a country where good records have been kept of asylum care and can be a rich source of evidence from which to address contemporary understanding of living with mental health in modern society.\u003c/p\u003e \u003cp\u003e3: Maximising the wellbeing agenda of the Change Minds project in participants ability to learn new skills, engage in a safe space of exploration, aligned to well facilitated peer support infrastructure can be mapped to achieve outcomes of improved wellbeing over the 12-week period, with potential for longer lasting sustainable impact over time.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe collaborative engagement of different organisations within an integrated care system, working as effective partnerships as the Change Minds project model showcases, offers a dynamic and responsive approach to addressing long standing community disconnections, enabling people on the outskirts of communities to find a place, and a creative space from which to safely explore new connections for their wellbeing. Building space for new relationships and connecting people through the archive research provides a powerful dynamic, as a means for addressing and achieving a level of social cohesion. Change Minds is addressing social isolation, and improving five ways to wellbeing, as other such social connected programmes of this nature have in addressing the issue of loneliness, isolation, and an improved sense of self (Laidlaw et al, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe twelves sessions of a curated Change Minds project have been seen to have Increased both participants, and the curators of the project\u0026rsquo;s knowledge of how to engage with historic texts, to gain a deeper engagement with the subject matter, whilst also addressing aspects of a modern process of caring for those living with a serious mental illness, connecting them to their local community, through an enriched understanding of the past.\u003c/p\u003e \u003cp\u003eParticipants increased well-being was also traced during the project, and is reported in the evaluation currently still underway, as achieved through new learnings, about how to undertake archive research. New skills were learnt, and new connections made, with the person from the past, but also with their peer group. Care and curation were also seen in how participants held a desire to remain \u0026lsquo;true\u0026rsquo; to the individuals being researched, expressing a heartfelt inspiration that even after 100 years had passed, this person was now able to help others explore their unknown contemporary colleague\u0026rsquo;s own health and well-being.\u003c/p\u003e \u003cp\u003eThe Change Minds project has offered people the chance to achieve deep reflections, about the causes, care and spaces within which mental health were treated in the past. With similar exclusions, embarrassments and behaviours as those undertaking the archive research have experiences themselves, in the modern day. This connection offered a reassessment of perception of care in the past, with some participants gaining considerable insights to the level of care on offer, the hope, optimism and achievements of those past inmates, inspiring and stimulating their own continued recovery journey, expressed through renewed skills, confidence and ability to enter new spaces with confidence.\u003c/p\u003e \u003cp\u003eHaving undertaken the 11 location-based projects, the Change Minds Project leads have learned lessons about the need for local adaptations, as venues, personnel and spaces required. As a result, Change Minds offers a promising approach to collaborative partnership working across local government, service providers, and charitable sector, that gives an effective facilitative operational model that offers additional adaptations that can allow for a multi-stakeholder integration approach to understanding living with mental health and addressing the five ways to well-being. When considered as a robust model of holistic, socio-ecological model of health and well-being, consistent potentials to Change Minds on the value of mental well-being can no longer merely be kept hidden and locked away.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLaura Drysdale and Gary Tuson were the originators of the Change Minds projects, and invited Sally Hardy to undertake the secondary analysis to achieve the evaluation for purposes of scalability and publication/dissemination.\u0026nbsp;\u003c/p\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e \u003cp\u003eUniversity of Dundee, School of Humanities and Social Science. Ref SREC22-011\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNational Heritage Lottery Fund. Ref NM-21-00407\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLaura Drysdale and Gary Tuson originated the Change minds project concept, funding application and learning, resource materials. Provided interview data and access to all change minds materials. Critical readers and contributed to writing the article. Sally Hardy undertook interviews, secondary data analysis and primary author\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAll data is available via the restoration trust and can be found through contacting the corresponding author, or via the website at www.changeminds.org\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data is available via the Restoration trust, and can be accessed via making contact on the Change Minds website www.changeminds.org\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAked J, Marks N, Cordon C, Thompson S. 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J., McGrath, R., Adams, C., Kumar, S., \u0026amp; Murray, C. M. (2023). Improved Mental Health, Social Connections and Sense of Self: A Mixed Methods Systematic Review Exploring the Impact and Experience of Community Reminiscence Programs. \u003cem\u003eJournal of Multidisciplinary Healthcare\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e, 4111\u0026ndash;4132. https://doi.org/10.2147/JMDH.S438730\u003c/li\u003e\n\u003cli\u003eMarmot M, Allen J, Boyce T, Goldblatt P, Morrison J. (2020). Health Equity in England: The Marmot Review 10 Years On. Institute of Health Equity. (health.org.uk/publications/reports/the-marmot-review-10-years- on). \u003c/li\u003e\n\u003cli\u003eMilligan C, Gatrell A, Bingley A. (2004). \u0026lsquo;Cultivating health\u0026rsquo;: therapeutic landscapes and older people in northern England. \u003cem\u003eSocial science \u0026amp; medicine\u003c/em\u003e. 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(1985). \u003cem\u003eThe female malady: Women, madness, and English culture\u003c/em\u003e, 1830-1980. Virago Press. London. \u003c/li\u003e\n\u003cli\u003eSzasz TS. (1960). \u003cem\u003eThe myth of mental illness\u003c/em\u003e. American psychologist. Feb;15(2):113.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Mental health action plan 2013\u0026ndash;2020. 2013. [Cited 1 April 2014.] Available from URL: http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf.\u003c/li\u003e\n\u003cli\u003ewww.legislation.gov.uk/ukpga/1998/42/contents (last accessed 29/4/2024)\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Change Minds Project Website: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://changeminds.org.uk\u003c/span\u003e\u003cspan address=\"https://changeminds.org.uk\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (last accessed 5/4/2024)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e National Lottery Heritage Fund Website: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.heritagefund.org.uk\u003c/span\u003e\u003cspan address=\"https://www.heritagefund.org.uk\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (last accessed 29/4/2024)\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"serious mental illness, wellbeing, social connectedness, integrated partnerships, community assets","lastPublishedDoi":"10.21203/rs.3.rs-4730707/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4730707/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eProviding sustainable mental health and wellbeing interventions for those living with serious mental illness remains an area of research interest and therapeutic improvement priorities globally. Any search for progressive mental health treatments often seeks to move away from traditional and historical approaches in search of novel innovations. The Change Minds project embraces the past as a significant data source for enabling those living with mental health issues to find creative connections, exploring how to think differently about what can be learned from the past that promotes living well with a mental health diagnosis. Change Minds is delivered in a unique tripartite organisational partnership approach, bringing together the National Archive Record Office, with local mental health service providers, linked to the original charity host, The Restoration Trust. For three years Change Minds has brought together small social groups of people living with mental health issues, supported by their mental health services, and introduced them to the process of searching local archive asylum records. The Change Minds project facilitates participants through researching asylum case records, identifying and following aspects of interest and curiosity about the daily lives of past asylum personnel. The project ends with participants seeking to represent their own research insights through a creative output or artefact of choice. Old and new social connections, creative expression and peer support have been tried and tested across several sites in England, to produce significant well-being outcomes. The project offers tangible evidence of personal growth, confidence and connection, in contrast to participants prior experiences of living with a serious mental illness such as consequences of social isolation and long-term internal turmoil, as a novel case study of integrated community care provision.\u003c/p\u003e","manuscriptTitle":"Partnering Curiosity with Creative Connections Through the Change Minds Project : An Integrated Commununity Case Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-20 09:37:02","doi":"10.21203/rs.3.rs-4730707/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8ba952d9-4965-4ec6-86ed-25311904a339","owner":[],"postedDate":"August 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-13T17:10:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-20 09:37:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4730707","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4730707","identity":"rs-4730707","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}