Double the drama

The author HH Williams said: “Furious activity is no substitute for
understanding.” The need to help professionals understand the
problems of the people they are working with was central to the
aims of Community Care award winner Cracked.

The project, which scooped the award in the drugs and alcohol
category, is run by east London-based Immediate Theatre, and uses
the arts to unravel the experiences of service users with a dual
diagnosis of mental health problems and problematic drug and
alcohol use.

Jo Carter is artistic director of the theatre, which has been
involved in using the arts to help the local community for many
years. “We wanted to work where we lived and make a connection
between art and the communities we live in and express the problems
that exist,” she says.

Some time ago, Carter was asked to do drugs work with young people
who also had other problems. “I felt then that the arts must have a
role to play in helping people to be more open about the reality of
drug-taking and to talk about harm reduction rather than some of
the more unrealistic messages that were around at the time about
just saying no,” she explains.

The opportunity to put some of her ideas into practice came when
she was working with the local mental health trust and the nurses
said it would be really great if the theatre could do some work
around people with a dual diagnosis of drug use and mental health
problems.

“There was an issue around mental health workers judging people who
used drugs, and in some cases feeling they were bringing their
problems on themselves,” Carter says. Some workers had an attitude
that many hospital beds were unnecessarily taken up by drug users,
and that somebody else should be dealing with that problem. “One
mental health nurse once told me: ‘We would be able to cope if we
didn’t have to deal with people with drugs problems – if we only
had to deal with people with mental health problems we would be
fine.'”

Meanwhile, drugs workers were feeling that they lacked the training
and understanding to deal with users with mental health
problems.

The East London and City Mental Health Trust asked the theatre to
tackle these problems, and to find a new training technique that
would be accessible to workers at all levels across the statutory
and voluntary sectors. Carter explains that they needed to educate
workers about how clients with dual diagnosis experience life, but
also to acknowledge that they caused staff high levels of stress
and anxiety. The Cracked project was born.

Cracked is a one-day awareness-raising workshop, and in setting it
up the project spoke to many staff and service users to find out
what they wanted and needed. Local artist and dual diagnosis
service user David Hugo was enlisted to create a series of artistic
installations using video, two-dimensional and three-dimensional
techniques, and sound. As part of their training day, participants
visited the installation, which explored attitudes to drugs from
many perspectives and was designed to help them to see life from
the dual diagnosis service user’s point of view. Themes included
how drugs are marketed, how a patient feels about the constant
note-taking, the stress of constant poverty, and everyone’s need to
seek moments of joy.

“One part of the exhibition was called ‘Can you hear me?’ and
consisted of David hidden by urine samples,” says Carter.

“We felt it was important to demonstrate how people often feel
dehumanised by their experiences.”

Another feature was the “out of control room”, a room with a bed,
old clothes and ashtrays but nothing of value or of hope.
Participants were asked to enter the room alone and listen to
sounds that suggested sensations of paranoia and alienation felt by
a drug users or someone experiencing a psychosis – whispering
voices, clocks ticking, someone sobbing and traffic passing through
space.

Participants were moved and forced to rethink their attitudes.
Their responses were used as part of the day, which also included
exercises to help develop networks between the voluntary and
statutory sector, quizzes about drugs, and the opportunity to
explore case studies. Feedback from participants, who were also
encouraged to contribute to a graffiti wall, was taken throughout
the day. Overall feedback was sent back to the trust
management.

Nearly 500 workers from more than 50 agencies in the east London
area have so far benefited from the training which has been well
received. Carter believes an important factor is that professionals
can come out of their usual team settings and be more open about
how they feel. “This sort of training is very useful because people
feel able to express opinions and perceptions that they often feel
worried about saying within their own teams, because of fear about
how they may be perceived,” she says.

Cracked has succeeded in turning attitudes around, and service
users have said that there has been a marked change in staff, who
seem to be developing a broader and less judgemental understanding
of the problems faced by dual diagnosis clients. “The exhibition
was excellent – raising awareness, tackling stereotyping and
stigma, and looking behind drug and alcohol abuse,” said one
participant.

As a direct result of the success of Cracked, the theatre has just
finished running a training programme specifically for staff
working with young people with mental health and addiction
problems. “We developed this training because more and more people
were saying that we are not getting to this problem early enough.
They felt they were only working with people once they had reached
a point of crisis,” Carter explains. The current programme aims to
look at the problems faced by young people that, if unnoticed and
untreated, often lead on to serious mental health problems and drug
and alcohol problems later in life.

“Winning the award was fantastic,” she says. “It felt great that
this problem has been acknowledged, which is very exciting,” says
Carter. “We are an arts organisation, and the recognition that the
arts are playing such an important role within community care was
fantastic. We are not very good at publicising ourselves – we
become so immersed in the project. This money will mean that we are
able to publicise our work more widely.”

The £5,000 prize money is a welcome addition to the theatre’s
coffers and will be used to promote its work. It is considering
creating a Cracked colour brochure about the project to be
distributed to other health authorities and voluntary sector
agencies to promote the work and encourage other agencies to
commission it.

“We are clear that we need to raise the profile of the work,”
Carter says. “A lot of people are saying we need to take it further
into the education sector. As well as promoting to other parts of
London we may look at promoting it to school workers – we are
touching the tip of the iceberg – and it’s about promoting the way
the project works and developing it for different sectors.” 

The drugs and alcohol category is sponsored by
Celsian.