A trust piloted a story and poetry reading group for patients with acute mental health problems, which encouraged them to relate to the texts and each other.
Training provided by The Reader Organisation enabled Berkshire Healthcare Foundation Trust to run reading groups for people in acute inpatient mental wards. A five-week pilot project provided an opportunity for patients to spend some time off the wards to enjoy reading together. The group offered a therapeutic space and a valuable opportunity for engagement and self-expression.
Citation: McLauglin S et al (2012) A reading group in acute mental healthcare. Nursing Times [online]; 108: 44, 14-15.
Author: Sue McLaughlin is nurse consultant, Berkshire Healthcare Foundation Trust; Sue Colbourn is group facilitator, trained by The Reader Organisation.
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Prospect Park Hospital is part of Berkshire Healthcare Foundation Trust. Two wards offer inpatient care for those with acute mental health problems. In response to patient feedback about boredom on the wards and requests for meaningful activity, initiatives to improve the patient experience are being developed.
In order to implement Star Wards - a project to enhance mental health inpatients’ experiences and treatment outcomes - key staff have met regularly to think about activities and share patient feedback across wards. In one meeting, the occupational therapist (OT) working on our rehabilitation ward described the positive impact a reading group was having there. This group had been running on a weekly basis for some months, and the OT was keen to see such groups introduced in other areas of the hospital.
The Reader Organisation provided the trust with training so that we could pilot a reading group for those in acute inpatient care. The group took place once a week for five weeks in an annexe between the two acute wards. The sessions provided an opportunity for patients to spend some time off the ward, in a safe environment, while enjoying shared reading.
The project demonstrated that this type of group offers a therapeutic space and a valuable opportunity for engagement and self-expression during what can be chaotic, difficult periods for patients on such wards. One patient said:
“It’s good to do this and get away from the ward for a bit; you can kind of get lost in it all.”
The Get Into Reading model
The Reader Organisation’s Get Into Reading model involves long-term weekly, shared “read aloud” groups which aim to:
- Improve mental health and wellbeing;
- Improve quality of life;
- Enable engagement and social interaction;
- Promote recovery;
- Reduce inequalities by improving the health of people in hard-to-reach groups;
- Build supportive communities through the shared reading of good books.
Each group caters for all abilities; a trained facilitator makes it clear from the outset that no one has to be able to read to take part. In a relaxed and friendly atmosphere, the facilitator reads aloud, slowly, taking time over each text, allowing thoughts, connections and understanding to emerge. The focus is on the text, not on the group, so individuals may join in as much or as little as they wish; they can choose to read aloud themselves or not, to share experiences or not. Interruptions are encouraged and often lead to spontaneous sharing of life experiences. Texts read include novels, short stories, poems, plays and works of non-fiction; the aim is to include a rich diet of good literature.
The Get Into Reading programme offers a model that builds partnership between library services, the health sector, and the third sector in an effort to form a connection between literature, health and readers.
What we did
The facilitator, trained by The Reader Organisation, worked closely with the nurse consultant, OTs and ward staff to ensure groups were well advertised and attended.
The number of patients attending varied between four and 10 each week, and accompanying staff numbered between two and five. The groups proved popular and were sometimes too big; the optimum number was 6-10. Sessions lasted for 90 minutes and, despite varying levels of concentration and other factors influencing group participation, the majority of patients were able to stay for the whole duration.
Each session began with reassurance about the nature of the group: members could control their own involvement, and the emphasis was on enjoyment and relaxation. Refreshments were provided to conclude the sessions and these were most often accompanied by general chat.
The texts chosen for the five sessions included short stories by contemporary writers such as Andrea Levy and Joanne Harris as well as more classic texts such as The Necklace by 19th-century writer Guy de Maupassant; poetry ranged from that of William Wordsworth, e.e. cummings and RS Thomas to that of more modern poets such as Mary Oliver. Each session always included a story and a poem; interestingly, on the occasions when group members offered to read aloud themselves, it was to volunteer a second reading of the poem.
Through the Tunnel, a story by Doris Lessing, was particularly memorable as it evoked strong feelings in many participants. One member of the group shared his own experience of a close family relationship, prompted by the description of the relationship between the mother and son in the story. This spontaneous and generous sharing of personal experience opened up that same possibility to others.
Patients engaged with each other’s sharing of life experience, through the medium of this text. One member told the group of a specific memory, evoked by the words “irregular cold currents shocked his limbs”. It clearly gave him pleasure to recall and recount the occasion.
Other issues that arose in this session were rites of passage, proving things to oneself and peers, breaking away from parents, and parents needing to let go. In reading and talking about Doris Lessing’s story, members of the group began to tell their own stories.
Seventeen patients attended over five weeks, with almost a third attending more than once. At times some people found it difficult to concentrate, and some needed to leave before the end of a session for various reasons, but such times were rare and evaluations of the pilot were extremely positive.
Sessions were evaluated using a survey consisting of 12 questions exploring patients’ experiences of the group, scoring these on a four point scale - agree, disagree, neither, not at all. Sixteen participants gave positive responses to all questions and one thought it was pointless and left before the end of the session. In addition to this, at the end of each session we served tea/coffee and talked over what participants got from the groups. Ward staff were also encouraged to provide their observations.
Eight members of staff attended various sessions, present not only in an observational capacity, but also as members of the reading group, a group in which hierarchies dissolved for a while through immersion in the text. There was a real sense of achievement after the sessions, of being involved in something worthwhile. Patients felt this too. One told a member of staff after the session:
“I love the stories. I was pleased with myself when I read it.”
Observing the groups was revealing in terms of the connections people made with characters, with words and with each other. The level of engagement with particular parts of the stories and poems - in patients who were so acutely ill - was remarkable. People clearly relaxed in the calm, inclusive environment created through the reading of the texts.
One patient said:
“I just like to listen and watch.”
“She [the facilitator] is a lovely reader. It’s so nice. It reminds me of being a little child. Just listening does something special to you. I was lucky to have a good childhood; you forget things like this at times.”
One patient, who attended three sessions, always took copies of the texts away, saying:
“I’m taking the story to read again before bed so I can take it all in and think about what we have talked about.”
The implication of this comment and of research on The Reader Organisation’s website is that the effects of shared reading aloud in this way are not confined to the 90-minute slot, and that something - more than simply a copy of the text - is taken away at the end of the group.
On reading Bertolt Brecht’s poem Everything Changes in the final session, group members were moved by what they felt was the hope presented within it. “This poem is for us in here,” one member commented.
We hope the case we have put forward for these therapeutically beneficial groups is sufficiently strong to secure funding that will allow them to be developed throughout the hospital.
The pilot showed clearly that acute wards - those wards all too often considered too busy or too acute for the provision of regular therapeutic activity - are the very places where these groups thrive.
However, we are keen to bring Get Into Reading to as wide an audience as possible - not just to patients, but to carers and to staff too.
We are interested in investigating more thoroughly the impact on individuals of shared reading aloud, and also the impact on general atmosphere and morale that the embedding of a reading culture within our organisation might have.
Our view, rooted in a belief in the transformative power of great literature, is that such shared experience can make a real difference in the lives of those who use, visit or work for the service.
- Star Wards is a project that works with mental health services and trusts to enhance mental health inpatients’ daily experiences and treatment outcomes - to “discover, celebrate, share, publicise and inspire excellence in inpatient care”.
- The Reader Organisation is a charity and social enterprise that works to bring about social change by sharing great literature with people of all ages, from all backgrounds and with all levels of reading ability.
- The Reader Organisation works in healthcare to share great literature with patients and staff
- One trust has piloted readings of stories and poems to patients with acute mental health problems
- The 90-minute “read aloud” sessions encourage patients to interrupt and share life experiences
- Participants in the sessions engaged with the content of the text and with each other
- The sessions were a good example of collaborative working between healthcare and the third sector