Tuesday 21 December 2010

Mental Health 2010 - Review of the Year 2010 part II


Questions

What was the mental health scene like in 2010 for those at the grittier end of the stick?  What was 2010 like for people in secondary care?  For people under community mental health teams?

Was there more recovery in 2010?  Were people in secondary care able to access mainstream more in 2010?  Were they less doomed to what Dr. Pat Deegan calls 'a career in mental health'?

Did people with severe and enduring mental  health conditions receive enough support from services? Did they receive the right support? Did the support help them or hinder them?

Some answers

Throughout 2010, statutory and voluntary services responded to the health challenge of independence and mainstream in several key ways.  Firstly, mental health teams set up some important initiatives.  These were geared towards client independence and recovery.  Many predominantly service-user led.

Recovery University in the south-west London borough of Merton enables secondary care  clients to access a wide spectrum of trainings and skillsets.  These include preparing for work, independence and life skills, confidence building, anger management and  many more.  Recovery University also trains service users as trainers for forthcoming courses.

Other community initiatives are also up and running, including wellbeing programmes and access to psychological therapies.  However, pyschological therapies in non-clinical settings are still not available should you happen to have a severe and enduring mental health condition.

Training the trainers often draws upon experiences and qualifications which service users have already gained within their life journeys.  Mainstream groups have also utilised service user skills as part of their own training programmes in areas such as visual  arts, music and creative writing.  This has taken the recovery university one stage further, providing paid employment and access to mainstream.

Statutory services continued to  have success in keeping people out of hospital or limiting hospital stays to a minimum.   The downside of this is that more and more people are being discharged from statutory services altogether.  In 2011 this will inevitably result in more pressure on GP services, as it is these practitioners who will become responsible under the latest government directives.

The rolling-out of the personalisation programme should mean more access to direct payments for many clients under mental health care plans.  It should also mean more and more creative uses of direct payments, as DP is being promoted for any activity or outcome that a client deems relevant to his or her recovery.  The Personal Stories videos on the NMHDU site bears witness to some of these outcomes.  With more and more people being discharged from mental health services, it is crucial that personalisation is a success in the new year.

Friday 10 December 2010

Mental Health 2010 - Review of the Year 2010 part 1

The background

Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a round-up and reinforcement of the initiatives embodied in the Disability Discrimination Act (DDA), designed to address key concerns around health and legal rights in the workplace.

Major businesses and business organisations have also addressed the massive loss to the economy and to human happiness that can be caused by mental ill-health.  In 2005 the Confederation of British Industry was concerned enough to commission its own research. Business owners and directors have not been slow in following the confederation's lead.

The year 2010

Supported by business ‘dragon’ Duncan Bannatyne, Mind’s ‘Taking care of Business’ campaign continues to highlight the initiatives being taken by many employers around issues of mental health at work. Some of the companies who signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.

Anti-stigma group Shift is also 'high visibility' in its tireless campaigning for an end to mental health discrimination and in its promotion of understanding the need to support good mental health in the workplace.

Equality Act

The increasing awareness of how mental health affects us all culminated in 2010 with the Equality Act.

The Act reinforces all the implementations of the Disability Discrimination Act (DDA) and in particular, the rights of employees who have disclosed a mental health condition. Before the act came into force, employees had the legal right to reasonable adjustments in their working conditions where appropriate. With the Equality Act, the burden of proof now lies with the employer to show that adjustments have been made rather than with the employee to prove they haven't. It is a highly significant rights-based change.

Friday 26 November 2010

Pat Deegan's Common Ground

Pat Deegan's Common Ground is an impressive new initiative in mental health recovery.  Common Ground incorporates goal planning, liaison with GPs and services, person-centred planning and monitoring of medication.  Plus a whole lot more.

Wednesday 17 November 2010

Are UK services ready for direct payments?

Within two years, by 2013, the Personalisation Programme is set to be rolled out across UK health and mental health services.

In June 2010 Eight Primary Care Trusts began roadtesting direct payments for personal health budgets.

'Patients will be offered more choice and control over their healthcare' announced Care Services minister Paul Burstow. 'The launch of the first direct payment scheme is an important step towards putting patients at the heart of everything the NHS does' he added .

The Coalition government has pledged its 'commitment to extend access' to direct payments. As Paul Burstow reasons, direct payments 'is a step away from the rigidity of the Primary Care Trusts deciding what services a patient will receive'.

Quite how the PCTs are going to be less rigid with their budgets is still unclear. Some formidable outcomes have already been achieved in some of the areas where the scheme is being piloted ( testimonial videos on NMHDU website). Nonetheless, the PCTs are still holding the budgets for direct payments.

Where direct payments is not being piloted or simply not understood, patients and carers are still being denied their rights. The 'rigid' approach is still being applied and clients wishing to access mainstream activities of their own choice are being turned down.

The Care Services minister has announced that direct payments 'will stop healthcare from slipping back to the days of one-dimensional, like-it-or-lump-it services'.

It is a great pity and possibly a legal scandal that clients wishing to determine their own recovery journeys are still being turned down by PCTs for direct payments.

'One-dimensional, like-it-or-lump-it services' are still around.

Tuesday 16 November 2010

Do care and support hinder recovery?

Care and support are not the only models or frameworks for mental health recovery. The establishing or re-establishing of what Dr. Pat Deegan refers to as 'valued social roles' can be held back by a mental health system that often encourages the client to choose 'a career in mental health' (Pat Deegan).

A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.

Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.

A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client.

Wednesday 10 November 2010

Equality Act 2010

During the parliamentary stages of the Equality Bill, mental health organisation Mind lobbied with other mental health and disability charities to get a ban on pre-employment questionnaires included in the Act. After securing cross-party support for the principle of a ban on questions that ask about a candidate's medical history and putting considerable pressure on Ministers, the last Government introduced a new clause to the Equality Bill making these questions unlawful.

The Equality Act came into force on October 1st 2010. The act bans companies from finding out whether potential employees are healthy enough to work for them prior to an offer of employment. Candidates will no longer be expected to declare medical issues during the recruitment stage unless it is specifically related to their job role.

Equality campaigners have long argued that employers discriminate against prospective employees with mental health issues, disabilities or a long history of illness, putting people off applying for a job.

However, 65pc of employers still ask a candidate about their health prior to a job offer, and 48pc ask potential employees to fill out a questionnaire detailing medical conditions and sickness records, according to a poll of 100 companies by law firm Pannone.

Jim Lister, head of employment law at Pannone, said: "The penalties for employers include investigation by the Equality and Human Rights Commission and the reversal of the burden of proof, meaning that the employer will be assumed to have discriminated, unless it can show there was another reason for non-selection.

Organisations that learn of a person's health issue after the job offer but fail to make reasonable adjustments and are forced to withdraw the offer face litigation, lawyers have said.

The reversal of the burden of proof is highly significant. Effectively this means that an employee who feels discriminated against on the grounds of mental ill-health, for example, is not required to prove that this is the case. It becomes the employer's responsibility to prove that this is not the case. If proved otherwise, the employer will be required by law to comply with equalities legislation and where necessary, to make reasonable adjustments on behalf of the employee.

Wednesday 20 October 2010

How mainstream is roadblocked

For many years mainstream has been perceived and practised as a key component of the care pathway in mental health provision.

At several stages of the pathway into mainstream there are roadblocks. These can occur from the individual client, from services, even from families and carers. An individual can feel apprehensive of stepping over the threshold into mainstream activities. This can be for a variety of reasons, ranging from self-stigma or from being so long in the mental health system that independence seems a very distant option.

Dr. Pat Deegan's belief is that too often the health system can encourage what she calls 'a career in mental health' and nothing else. This viewpoint is based on her experience as a service user and it still holds true.

A great deal is being achieved by service users themselves to challenge the roadblocks. This is particularly true where creative and personalised use of direct payments and individual budgets have really taken off around the UK. It hasn't happened everywhere but some immensely inspiring stories and testimonials can be viewed at the NMHDU website

Creative use of direct payments in mental health recovery is currently sporadic. Inevitably, this will increase as the move towards personalisation and invididual budgets spreads to become policy all over the UK. This is the planned scenario for what could be as early as 2013.

Where the personalisation pilot schemes are not operating, the entire perception of direct payments and mainstream can be frankly primitive. Individuals under a care plan have a right to direct payments which is often supported wholeheartedly by local direct payments departments. Scandalously, DP can still be denied by the Community Mental Health Teams, even where it is proposed for an individual by the client's own key worker, carer and the client him or herself. This is because direct payments comes out of the Community Mental Health Team budget and is sometimes vetoed by senior members of the team on financial grounds. What this amounts to is direct intervention to block recovery.

Of course any client is free to fund their own mainstream recovery pathway and many do. The outcomes in this area alone (south-west London) have often been formidable. A composer who has funded her own recordings and launches now has self-employment through her music. Many are those who have accessed adult education courses and further training. Individuals have re-accessed faith venues which they had previously felt unable to enter for many years.

Not all these initiatives require direct payments. Many are free to access or funded by individual clients from their own pockets. Where direct payments is a requirement it can often make a crucial difference

Thursday 26 August 2010

Rachel Perkins Guardian interview August 25th 2010

The phrase "going against the grain" could have been invented for Rachel Perkins. Bring up any contemporary issue surrounding mental health and, chances are, the Mind Champion of the Year will come back with a question about why a particular approach is being taken and then advocate for an alternative.

State benefits, a hot topic, is a case in point. As someone who describes herself as "a child of old Labour", Perkins appears slightly uncomfortable that her views on benefits are in some ways in line with those of the Conservative and Liberal Democrat coalition government. She says she is "torn" by some Conservative plans, such as caps on housing benefit, yet is in agreement with the proposal for "tapering" benefit payments so that people are incentivised to work. "So that every hour that someone works counts," she says.

Equal citizens

She goes on to argue that the focus by some campaigners on defending entitlement to benefits can reinforce the perception that people with mental health difficulties need to be cared for, rather than being thought of as equal citizens. "Instead of talking about the right to work, we are now talking about the right to benefits. I don't think that's terribly healthy," she says.

"Every human being gains their self-worth from being able to contribute to their communities – and let's face it, the most socially sanctioned way to do that is with work."

Perkins, a clinical psychologist, is probably best known for her impressive efforts to get people with mental health problems back into work, and has spearheaded employment programmes at South West London and St George's mental health trust.

Civil rights is at the core of what Perkins advocates, and she raises the topic frequently. Discussions around mental illness should resemble those around physical disability, she says, where the emphasis has been successfully rooted not on impairment but in a "rights-based agenda". In part, her inspiration heralds from a strand of mental health advocacy in the US that promotes a "peer support" approach to recovery and firmly places mental health in the realm of a broader rights agenda.

The difficulty for mental health campaigners in Britain, she suggests, is that they can end up ghettoised when they should be tapping into wide-ranging issues around exclusion. Equally, too many of the messages put out about mental illness are couched in negative terms, she claims. "The mental health movement has spent so long looking inwards at the sort of services people get, not better lives. One of the things I really hated about the mental health world was its aura of doom and gloom. It was always, 'You can't do anything because of stigma and prejudice.' [The] image of possibility often gets lost in the conversation about stigma. I'm not some romantic, but [change] is possible."

In particular, Perkins gives short shrift to anti-stigma campaigns, which have attracted substantial funding in recent years. "I don't have any evidence that they [work]. I prefer not to use the term stigma, because it attaches to the person. We don't talk about the stigma of race. We talk about racism. The problem with anti-stigma campaigns is that they identify the class of people by their impairment," she says. "I want to see some empirical data [that they help people to get] a home and a job. The bottom line [is] I want to change behaviour."

Discrimination

As her long career in the NHS nears its end, one of the themes that Perkins, 55, intends to persevere with is challenging the expectations of the state and employers when it comes to getting people into work and keeping them there. Mental health awareness training is not the answer to discrimination, she insists, adding that it is wrongheaded to demand that employers do the "heavy lifting" for people with mental health problems in the workplace when the state should do more.

When asked in 2009 by the last government to head a review into how to support more people with mental health problems into work, for example, Perkins proposed that employers be given financial compensation by the state to cover some of the cost of long periods of health-related absence.

The ability to work was vital to how Perkins dealt with her own mental health difficulties, which manifested in the early 1990s. But her ambition goes beyond getting people jobs. She wants a transformation in how mental health is perceived. "We've got to look at civil rights in the context of mental health and citizenship, rather than, 'You are a poor unfortunate.' That kind of thing is a hiding to more discrimination."

Spitting people out

Perkins's career path offers some insight into how her views have evolved. She considered going into academia after finishing her PhD but quickly came to the conclusion that research was dull. She applied to train as a clinical psychologist only to find herself rejected as someone who would "wilt" outside the confines of a university. Undeterred, she applied for and got a job as assistant psychologist at Broadmoor, the high security psychiatric institution.

The experience reaffirmed what she instinctively felt: "I've always been concerned about the way our society is very good at spitting people out at the bottom. That's always bothered me."

Clinical training followed, as well as several other jobs, including stints in "the old state bins", the large Victorian asylums that once warehoused patients. Perkins attributes her belief that work is the best route to a better life to those early experiences. She describes one institution she helped close in 1990: "There were 40 beds to a dormitory. There were four baths in every bathroom. It's not a long time ago. They weren't safe places. Far from it. The average stay in that place was 30 years."

Winning the Mind Champion of the Year award last month is particularly special, says Perkins, because it was voted for by the public. Perkins beat household names such as Bill Oddie and Ruby Wax to take the gong. "I think [winning the Mind award] was much nicer than the OBE [awarded in June]," she says. "Being voted for was much better."

Perkins has no intention of easing into retirement and will be taking up consulting roles. "We've got to totally rethink mental health services," she says. "We need to be building up communities to accommodate mental distress and put professionals back in their boxes. I think what we've done is over-professionalise mental health."

Elaborating, Perkins explains that the irony of improvements in mental health service provision over the past 30 or so years – such as closing large asylums, introducing community-based services, and better access to a range of therapies – is that mental illness has been pathologised in a way that unwittingly promotes social exclusion of "a whole class" of people.

"The more we've developed highly sophisticated mental health services, the more, when we experience distress, we think, 'I've got to go to the experts.' Then [our] nearest and dearest think, 'Oh my god, they are not safe in my untrained hands. I've got to leave it to the experts.'"

It's not that mental health professionals aren't important or that therapy, drugs and other kinds of treatment don't have their place, Perkins insists. It is that an over-reliance on them stalls progress. "I'm not opposed to medication [for mental illness]. It's one of the things I use," she says.

What concerns Perkins is that often when trying to improve services – the recent emphasis by politicians and practitioners on "talking therapies", for example – the bigger questions around civil rights, dignity and independence are lost. "I don't believe that psychological therapy solves all ills. The more we translate the entire human process into therapy the more we render ordinary human misery and disturbance to the experts," she says.

Perkins's continued outspoken views on what still needs to change in the mental health arena are likely to ruffle the feathers of her fellow professionals and, if the ideas she promotes are eventually adopted, they could radically alter the way services are delivered

Wednesday 18 August 2010

Recovery news from NHS North West

Manchester Mental Health and Social Care Trust are committed to a recovery approach to mental health care. One element of this is to support service users who want to move into employment. They are currently piloting an Individual Placement and Support (IPS) service, funded by NHS North West.

The project consists of three Employment Specialists, based with Community Mental Health Teams, who help service users to find and remain in employment. The service offers help in preparing for work and engages with both employer and employee to provide ongoing support.

Joanne, one of the service users, is just one of the people to benefit from the pilot so far. After discussing her wish to get back into work with her Community Psychiatric Nurse (CPN) she was referred to the team's Employment Specialist who used the Mental Health Recovery star to talk through Joanne's situation and where she wanted to be in terms of finding a job. They then developed an action plan and the Employment Specialist helped Joanne to find jobs that were suited to her work history and aspirations. Joanne decided that working part time would be the best way to ease back into work life and through regular meetings, the Employment Specialist helped her to explore job vacancies. Eventually they identified one position that suited Joanne in terms of job description, location and number of hours.

The Employment Specialist arranged a meeting with the Disability Employment Adviser at the local Job Centre for support with in-work benefit calculations, and completing a permitted work form with a supporting letter from the Employment Specialist. 10 weeks after engaging with the IPS service, Joanne was successful at securing a Receptionist post for 12 hours a week and stays in touch with her Employment Specialist who provides in work support.

For more information please contact Zeph Curwen, Service Manager Occupational Activity & Employment, zeph.curwen@mhsc.nhs.uk or 0161 720 4809.

For more information on the IPS project contact Lucy Rowe in the Health and Work Programme, Workforce Directorate: lucy.rowe@northwest.nhs.uk or 0161 625 7350.

Tuesday 17 August 2010

MHFA - crisis intervention

In addition to the umbrella intervention provided by ALGEE (Assess Risk, Listen non-judgementally, Give reassurance, Encourage referral to other agencies, Encourage self-help strategies), MHFA has strong and clear guidelines for crisis intervention. From MHFA:
Crisis First Aid for someone experiencing an acute psychotic episode
  • Do not get involved physically
  • Call the police and explain what is happening, unless the person has a mental health crisis card with clear steps describing how you can help.
  • Try to create a calm, non-threatening atmosphere.
  • Be reassuring, calm and concerned.
  • Do not try to reason with someone who is experiencing acute psychosis.
  • Express empathy for the person’s emotional distress.
  • Comply with reasonable requests

Monday 16 August 2010

MHFA Testimonials & Feedback

MHFA Training delivered by Middlesbrough and Stockton Mind on behalf of the NE Mind Partnership have trained over 1800 individuals with outstanding feedback and results.

Mental Health First Aiders were asked for there stories on how MHFA has helped them. These are just a small selection;

I use MHFA daily, for example I had a tenant suffering a psychotic episode which I felt confident to deal with

I have used MHFA when a young Mum came into the centre and told me she felt like ending it all

I use it on a daily basis with clients and colleagues and feel I have made a real difference

I have a work colleague who suffers from epilepsy and associated depression and anxiety. I used ALGEE and offered advice and guidance over the phone.

Friday 13 August 2010

MHFA interventions

Mental Health First Aid (MHFA) promotes five basic interventions for a qualified mental health first aider who comes into contact with signs and symptoms of a mental health condition. The action plan for Mental Health has five basic steps under the mnemonic ALGEE.

1. Assess risk (to oneself and the client)
2. Listen non-judgementally
3. Give reassurance and information
4. Encourage the person to get appropriate help and support
5. Encourage self-help strategies

Mental health condition can present across a spectrum, from mild sub-clinical concerns through to severe anxiety, distress and even full-blown psychosis.

A mental health crisis can occur when a person may feel suicidal or having anxiety attacks or be in an acute stress reaction or a person may be out of touch with reality in a distressing psychotic state. MHFA helps participants to develop and practice general strategies in a safe environment, that can be used in a first aid situation.

For a more in-depth course on suicide intervention skills it is recommended to attend an ASIST (Applied Suicide Intervention Skills Training) course.

Saturday 24 July 2010

Mainstream - the Cascade Effect

As a social inclusion bridge builder I work with clients with severe and enduring mental health diagnoses. They are referred or they self-refer with the desire to access mainstream life domains.

Clients aspire to a variety of mainstream choices. It might be volunteering or befriending, it may be arts activities, it might be employment or running your own business. Client aspirations may include sports, faith, education, training or a selection from any or all of these.  All drawn from the life domains identified as key by the inclusion think-tanks of the late 90s and early 2000s.  Access to mainstream as a key component of the care pathway.

Enabling individuals with a 'severe and enduring' background is not always a straightforward process although it certainly can be sometimes. A client can be introduced to a mainstream outlet and it can work for him or her almost immediately. Other clients may be unready for mainstream for a variety of reasons. They may suffer a relapse before accessing the mainstream environment. They may visualise mainstream as another form of day service or statutory support system, which it isn't.

Equally, clients can sometimes express a wish to access mainstream out of a misplaced fear that not accessing it might in some way affect their payments and benefits. It can be a long process before the value and rewards of mainstream are understood.

What is true is that clients who successfully access or re-access mainstream in turn become examples of mainstream's effectiveness. Signposting to mainstream as part of the mental health recovery pathway is undoubtedly effective, even if it does not work for everyone straight away.

Mainstream also helps to sustain recovery in the individual and even better, it can propagate more success and recovery out of its own resources. An example of this would be the musician who successfully links up with a mainstream recording studio. After months of regular rehearsal the musician is invited by the studio manager to contribute to a recording session. I witness this kind of beautiful outcome and its benefits for the client in my work as an arts bridge builder.

Another example - again from music bridge building - is the guitarist client who uses a studio regularly and invites a friend to join him during the session. The friend may well be another mental health service user who has never successfully engaged with mainstream despite the best efforts of the bridge building service. Where services have been unsuccessful a friendship and peer network can do the job far more effectively.

Mainstream reaches the places other services cannot reach and in the process it is able to create a cascade effect - a continuing path of development, recovery and individual growth.

A mainstream model for recovery

Care and support are not the only models or frameworks for mental health recovery. The establishing or re-establishing of what Dr. Pat Deegan refers to as 'valued social roles' can be held back by a mental health system that often encourages the client to choose 'a career in mental health' (Pat Deegan).

A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.

Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.

A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client not by the bridge builder.

Wednesday 14 July 2010

Discussing Mainstream

Bridge building for mainstream is now incorporated into the care pathway for people recovering from mental health conditions.

Community mental health teams, occupational therapies, psychiatrists are all aware of the value of mainstream bridge building. Many community mental health teams actively promote mainstream as part of their in-house practice with clients. Service-user led initiatives are also widely encouraged.

Where mental health teams may not always the time and resources to promote mainstream fully, there are many outside organisations working alongside the teams. The benefits of referral to an outside non-clinical team can be considerable.

Mental health teams can often discuss mainstream with clients in a clinical or home setting. An outside organisation has more time and capacity to draw clients out into mainstream settings where a conversation can begin. This may well be and should be - a conversation about the client's hopes, dreams, goals and aspirations.

One of the bridge builder's roles is to help facilitate this conversation. Another role is to be clued-in with what mainstream has to offer. For example, a bridge builder specialising in arts and culture needs to know what outlets there are both locally and further afield. A client who wishes to develop skills in music production should be introduced to the mainstream venue or venues where this opportunity takes place.

Tuesday 13 July 2010

History of Social Inclusion

Social Inclusion and mainstream arise out of a history and out of a history of ideas.

Government think-tanks in the late 1990s and early 2000s had a key role in developing current thinking and practice around social inclusion. The envisaging of 'social domains' relevant to people's lives arises from these seminal ideas. The role of mainstream bridge builder is also developed around the concept of mainstream as a pathway for mental health recovery.

Social Inclusion goes back even further. The single act of defiance by Rosa Parks in 1955 in Alabama Mississippi. A black woman refusing to give up her seat on the bus to a white person, thereby defying the segregration laws. A key moment that lies at the heart of the civil rights movement, not just for the United States but for equality and social inclusion everywhere.

Equal opportunities, diversity, social inclusion and fairness are now commonplaces, enshrined in the way we strive to live and work today.

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Social Inclusion Web

Two major assessment tools have been developed for social inclusion.  One is the social inclusion 'Web' and the other is the 'Star' or 'Recovery Star'. 

Originally created by the National Development Team (NDT) the web is a simple and effective assessment tool based on five key social domains.  The domains were identified as key in the research done in the late 90s and early 2000s around social inclusion.  Other domains were identified alongside these and on the social inclusion web these appear as: Employment, Education & Training, Arts & Culture, Faith & Cultural Communities, Volunteering & Befriending.  Family & Neighbourhood and Services also have sections on the web.

Wednesday 30 June 2010

Social Inclusion - so good for business

The business case for mental health awareness is evidenced by the increasing numbers of employers who are commissioning mental health awareness trainings for their workforce. Employers want trainings which enable their staff to understand more about common mental health conditions. Understanding mental health means that staff can work better with clients and customers. It also allows staff to feel less isolated about personal issues around health and well-being.

Mental health awareness provides the opportunity for employers and employees to find out more about the law as it relates to employment and mental health.

Enlightened employers will seek to develop a workforce team which is happy rather than unhappy, fulfilled rather than excluded. Courses such as MHFA (Mental Health First Aid) show that attendees often feel that one of the benefits of the training in that it allows for a safe space. A safe space where individuals can share feelings about their personal well-being in addition to learning about the broader aspects of mental health conditions and the appropriate interventions.

In addition to mental health, it makes solid sense for businesses to incorporate awareness of social inclusion and mainstream. Returning to or accessing mainstream living is now a key part of the care pathway for those diagnosed with 'severe and enduring' mental health diagnoses. It is equally important for people who may be experiencing conditions such as anxiety, phobia or stress at work.

Both groups - those in primary and secondary care - are being signposted to mainstream life rather than to special settings as a central plank of the recovery process. The implications for any service provider - and that includes businesses - are crucial. Businesses and services are at the receiving end of mainstream.

Clients in recovery are choosing to access their personal goals through a diverse range of outlets. These could range from faith venues to volunteer bureaus, from retail outlets to sports centres, from recording studios to adult education colleges, from libraries to personal counselors, from training venues to department stores.

For businesses, it's not just one in four of their staff who may be experiencing mental health challenges, it's also one in four of their clients, customers and service consumers. Mental health challenges will also have an impact on one in three families. Disclosed or undisclosed, it's clear that mental health and well-being lie at the heart of our transactions and interactions.

Tuesday 29 June 2010

MHFA England John Vanek: Social Inclusion

MHFA England John Vanek: Social Inclusion

The Business Case for Mental Health Awareness

The Business Case for Mental Health Awareness. The economic and social cost of mental health problems in the United Kingdom is well documented. In 2002/03 the economic and social cost of mental health problems in England was £77 billion. (SCMH, 2003). The economic and social cost of mental health problems is greater than that of crime and larger than the total amount spent on all NHS and social services in the UK (HM Treasury, 2005).

Dame Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a major attempt to address these concerns. Legislative review such as the 2005 amendments to the Disability Discrimination Act (DDA) highlighted the need to address the massive economic and social attrition behind issues of mental ill-health. In 2005 the Confederation of British Industry was concerned enough to commission its own research. Stress, anxiety and depression accounted for a third of the 168 million working days lost in the UK for health and related reasons in 2004, translating to a cost of sickness absence of about £4.1 billion (Confederation of British Industry, 2005).

As a result of legislation, employees have more rights and employers more responsibilities relating to the incidence of mental health in the workplace. Employees who choose to disclose a mental health condition to their employers are strongly protected by legislation and have the right to 'reasonable adjustments' that they may request their employers to make. In practice, it is still true that people with mental health diagnoses may well feel little confidence in this legislation. Nonetheless, their rights are enshrined in law. Similarly, employers have a legal responsibility not to discriminate against employees who have disclosed a mental health condition and to make any reasonable adjustments that have been requested.

Employers getting down with mental health

Helping employers to understand issues around mental health is fast becoming a key component of approaches to productivity, staff happiness, improved services and profits.

It is employers, managers and directors who are taking the lead on many of the new initiatives around mental health.

Supported by business ‘dragon’ Duncan Bannatyne, Mind’s ‘Taking care of Business’ campaign highlights the initiatives being taken by employers around issues of mental health at work.

The Mind campaign underlines the message that the promotion of good mental health helps employers ‘increase productivity, improve staff performance and save thousands of pounds’.

Mind also hosts a series of follow-up programmes designed to actively encourage good mental health in the workplace.

Some of the companies who have signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. James Kenrick at Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.

Hewitt also initiated a staff health audit which identified stress, anxiety and depression as ‘real issues within the organisation’. James Kenrick states that:

‘after the health audit we sourced a stress vocational rehabilitation service, which has a vocational focus and is staffed by psychologists. Employees who have been absent for 10 days or more are referred for an initial assessment, and recommended the most appropriate treatment plan. We have found that this service, along with early intervention, has greatly reduced the days lost through stress-related absence and stopped stress-related disability altogether’.

Proactive management of mental health in the workplace has allowed Hewitt Associates to save ‘nearly £400’ per employee. More importantly, as Kenrick states:

‘it's the intangible elements that are most rewarding. The feedback from staff who have been helped to recover from difficult circumstances has been exceptional’.

EDF Energy is a major electricity provider. A workplace audit showed that the company was losing around £1.4m in productivity each year as a result of mental ill health among its employees. As part of an Employee Support Programme the company offered psychological support (cognitive behavioural therapy) to employees and trained over 1,000 managers to recognise psychological ill health among staff and to minimise its effects. This resulted in an improvement in productivity which saved the organisation approximately £228,000 per year. Job satisfaction also rose from 36 to 68%
(Business in the Community, 2009).

Thursday 24 June 2010

Happiness and Profits

Helping employers to understand issues around mental health is fast becoming a key component of approaches to productivity, staff happiness, improved services and profits.

It is employers, managers and directors who are taking the lead on many of the new initiatives around mental health.

Supported by business ‘dragon’ Duncan Bannatyne, Mind’s ‘Taking care of Business’ campaign highlights the initiatives being taken by many employers around issues of mental health at work.

The Mind campaign underlines the message that the promotion of good mental health helps employers ‘increase productivity, improve staff performance and save thousands of pounds’.

Mind also hosts a series of follow-up programmes designed to actively encourage good mental health in the workplace.

Some of the companies who have signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. James Kenrick at Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.

Hewitt also initiated a staff health audit which identified stress, anxiety and depression as ‘real issues within the organisation’. James Kenrick states that:

‘after the health audit we sourced a stress vocational rehabilitation service, which has a vocational focus and is staffed by psychologists. Employees who have been absent for 10 days or more are referred for an initial assessment, and recommended the most appropriate treatment plan. We have found that this service, along with early intervention, has greatly reduced the days lost through stress-related absence and stopped stress-related disability altogether’.

Proactive management of mental health in the workplace has allowed Hewitt Associates to save ‘nearly £400’ per employee. More importantly, as Kenrick states:

‘it's the intangible elements that are most rewarding. The feedback from staff who have been helped to recover from difficult circumstances has been exceptional’.

EDF Energy is a major electricity provider. A workplace audit showed that the company was losing around £1.4m in productivity each year as a result of mental ill health among its employees. As part of an Employee Support Programme the company offered psychological support (cognitive behavioural therapy) to employees and trained over 1,000 managers to recognise psychological ill health among staff and to minimise its effects. This resulted in an improvement in productivity which saved the organisation approximately £228,000 per year. Job satisfaction also rose from 36 to 68%
(Business in the Community, 2009).

Friday 18 June 2010

Freeindex Profile

If you have attended a recent training, please feel free to review me.

Freeindex listing:
View our full profile in the FreeIndex Personal Development Directory directory.

Monday 14 June 2010

Planning for Good Mental Health & Social Inclusion - testimonials

Planning for Good Mental Health & Social Inclusion

Training testimonials from NHS and Primary Care attendees

'Such a huge subject - well covered in the time allotted'.

The course has enabled me to be 'more assertive in recognising and prioritising mental health issues'.  I shall 'develop a knowledge base of local services and encourage others to make appropriate referrals'.

'John is a very calm person. Used the background music to create a non-threatening, relaxed atmosphere'.

I shall 'explore in greater depths what services are available to individual clients'.

'I feel I am more aware of what to look for in myself and others'.

The course 'has made me more aware of the need to ensure people return to mainstream after illness'.

'Ideas and information given to think outside the box'.

The course reinforced 'the importance of mainstream social inclusion'.

I now have 'more awareness of organisations and can utilise the social inclusion 'web' tool in assessments.'

Write a Freeindex Review

If you have attended a recent training, please feel free to review me.

Freeindex listing:
View our full profile in the FreeIndex Personal Development Directory directory.

Traditional cohorts in mental health

Service providers, staff, service users and carers are often perceived as the main groups comprising the traditional cohort of secondary mental health care provision.  All this changes when mainstream practice is incorporated into care pathways.  


The effect of mainstreaming is that it introduces new stakeholders into the equation. Stakeholders chosen by the client as part of his or her recovery.  Person-centred practice is designed to enable the person in recovery to access activities and outlets of their own choice in the mainstream environment.  These outlets can be anywhere and everywhere, depending on the client's personal goals, hopes and aspirations.


Mainstream effectively destroys the stigma attached to recovery as it is longer attached to special settings,  wherever this is the individual's preferred choice.

Wednesday 9 June 2010

Mind and Mental Health in the Workplace

Mental Health organisation Mind is getting behind mental health in the workplace and has come up with an impressive campaign 'Taking Care of Business'. 

Mind Workplace also provides consultancy and training for employers on mental health, enhancing productivity by improving business practices.

'Mind Workplace will enable your company to assess how mentally healthy it is for both employees and clients and support you to make any necessary changes to ensure you are managing mental health in a way that will maximise your company's potential.

We believe in a preventative approach to mental health problems in the workplace. This involves promoting mental health awareness, reducing stigma around seeking help, helping staff develop resilience, effective sickness management and emotionally intelligent management supervision.

Building on existing good practice such as employee assistance programmes and occupational health support, Mind Workplace will help you to develop a proactive and systematic approach to promoting good mental health in the workplace.

If you would like to contact us to find out how you can improve the mental health of your business then call us on 020 8215 2365 or fill out our contact form.

Why does your company need Mind Workplace?

In the past five years, employers have cited stress as the number one reason given by employees who take time off work.

Staff absence and lost productivity due to poor mental health management have an overall annual cost to employers of nearly £26 billion [1].

Healthy and happy workplaces result in reduced absence, increased productivity and greater customer satisfaction, leading to higher profit margins.

One in four people experience mental health problems in any five year period - therefore a significant proportion of your business's employees and customers will be experiencing mental health problems at the moment.

People with mental health problems are often overlooked by interventions aimed at improving accessibility of business services to people with physical disabilities.
Most firms vastly underestimate the problem but they could make big savings with a few simple steps.

What next?

Contact us today using this form or on 020 8215 2365 to arrange a meeting'.


(From the Mind website)

Friday 4 June 2010

'Taking Care of Business' Mind campaign

Mind’s ‘Taking care of Business’ campaign highlights the initiatives being taken by many employers around issues of mental health at work.

Supported by business ‘dragon’ Duncan Bannatyne, the campaign shows that employers are becoming aware of the need to address and support good mental health in the workplace.

The Mind campaign underlines the message that the promotion of good mental health helps employers ‘increase productivity, improve staff performance and save thousands of pounds’.

Mind also hosts a series of follow-up programmes designed to actively encourage good mental health in the workplace.

Some of the companies who have signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. James Kenrick at Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.

Hewitt also initiated a staff health audit which identified stress, anxiety and depression as ‘real issues within the organisation’. James Kenrick states that:

‘after the health audit we sourced a stress vocational rehabilitation service, which has a vocational focus and is staffed by psychologists. Employees who have been absent for 10 days or more are referred for an initial assessment, and recommended the most appropriate treatment plan. We have found that this service, along with early intervention, has greatly reduced the days lost through stress-related absence and stopped stress-related disability altogether’.

Proactive management of mental health in the workplace has allowed Hewitt Associates to save ‘nearly £400’ per employee. More importantly, as Kenrick states:

‘it's the intangible elements that are most rewarding. The feedback from staff who have been helped to recover from difficult circumstances has been exceptional’.

EDF Energy is a major electricity provider. A workplace audit showed that the company was losing around £1.4m in productivity each year as a result of mental ill health among its employees. As part of an Employee Support Programme the company offered psychological support (cognitive behavioural therapy) to employees and trained over 1,000 managers to recognise psychological ill health among staff and to minimise its effects. This resulted in an improvement in productivity which saved the organisation approximately £228,000 per year. Job satisfaction also rose from 36 to 68% (Business in the Community, 2009).

Friday 21 May 2010

Recovery

Recovery

Recovery is a process of hope and aspiration that signals the return to mainstream life for those who have experienced mental health problems. Recovery can take place regardless of whether the individual is symptom-free or not. Hope and recovery are recognised as key parts of the care pathway. Social inclusion bridge builders work with clients on a recovery programme based on the client's own choices and aspirations.
More about Recovery and the work of Dr. Pat Deegan

Wednesday 12 May 2010

Who should take an MHFA England course?

Who should take an MHFA England course?

Anyone can benefit from Mental Health First Aid (MHFA). It is open to members of the general public. Families affected by mental health problems, teachers, health service providers, emergency workers, frontline workers who deal with the public, volunteers, human resources professionals, employers and community groups are just a few of the groups who have benefited from MHFA.

Mental Health First Aid covers a comprehensive range of common mental health conditions and their appropriate first aid interventions.  The conditions covered range from psychosis to phobia, from bi-polar to anxiety, from schizophrenia to stress at work.  From this point-of-view MHFA is highly intensive, detailed and excellently put together.

It is important to bear in mind that MHFA is more than mental health awareness.  A good mental health awareness course may well be a good 'Level I' for those who wish to find out more about general  mental health before deciding to go on to MHFA at 'Level II'.

Social Inclusion Facebook Group

Social Inclusion facebook group is now up and running.  It's open to anyone interested in social inclusion, mainstream living, mental health, aspiration, goals and the arts.  So welcome friends!

Tuesday 4 May 2010

Talking Therapies - are they all they're cracked up to be?

Lord Victor Adebowale, Chief Executive of the charity Turning Point, calls access to psychological therapies as 'the biggest shift in mental health provision in the last 50 years'. (Big Issue April 5th 2010). Lord Victor goes on to state that IAPT (Improved Access to Psychological Therapies) 'gives a lot of people access to psychological treatment who suffer from depression and anxiety, whose relationships may have broken down or who have housing issues. It's the first intervention in that triage, and it's a path for people to get their lives back together'.

It's great that Lord Victor feels so positive about Improved Access to Psychological Therapies (IAPT). Turning Point as an organisation may well be equipped to help deliver therapies to more and more people in an increasingly effective way. It's also the case that psychological therapies are more readily available in some areas, through being delivered in community settings such as family centres and libraries.

However, for many people in the mental health system, particularly those diagnosed as having a 'severe and enduring' condition, psychological therapies can be exceptionally difficult to obtain. Firstly, the IAPT programme is only available to people in primary care who are under a GP. There is no eligibility for IAPT if you happen to be in secondary care or under a community mental health team. The reason for this is that people in secondary care are deemed to have therapeutic provision 'in-house' or within the professional team. If an individual is under section and hospitalised, he or she has the legal right to psychological therapies within 2 or 3 days of their request.

What happens in practice is often very different.  A colleague desperate for therapy applied for it from his secondary care team (his legal right).  Pushed from pillar to post, he finally received therapeutic treatment only through the intervention of the local MP. In the absence of a therapist being in post at the time, the treatment was delivered by the Head of Clinical Services.

It is great that charities like Turning Point are promoting greater access to psychological therapies. It is also great that therapies are being delivered in some locations through a slimmed-down faster process such as a well-being service. Nonetheless, if you happen to be someone with a 'severe and enduring' mental health diagnosis you will have no access to the IAPT programme. The accessible therapies under secondary care depend entirely on whether there is a suitable professional in post within your community mental health team. Despite rights enshrined in law, service users with a 'severe and enduring' condition are often denied psychological therapies.

Monday 3 May 2010

How people with mental health conditions enrich the work environment

How people with mental health conditions enrich the work environment.

People with mental health conditions who are returning to employment or even accessing it for the first time can often make exceptional contributions to the workplace.  An art tutor who understands mental illness from first-hand experience will apply non-discriminatory and more inclusive practice alongside his or her skills.

Identifying a suppressed aspiration as the cause of stress at work can lead to formidable achievement when previously hidden dreams are pursued and developed in the appropriate mainstream setting.  This too creates employment or self-employment alongside increased cashflow and profits for service providers who are helping dreams to become reality.

How businesses profit from mental health

How businesses profits from mental health.

Businesses and services are developing the understanding that informed practice around mental health benefits both service delivery and profits. Staff are happier and more productive when they know that their employers' practices and procedures do not stigmatize or discriminate against illness or experience.

Days lost to absenteeism, sickness or unproductive presenteeism decrease when employees are not anxious about being dismissed should they choose to disclose a mental health condition.  The attrition of unexplained job resignations or sudden departures decreases when taboos around mental health are dismantled by enlightened policies and staff trainings.

Business and services profit from individuals who are being signposted to mainstream as part of their recovery plans. Mainstream social inclusion takes place in any outlet where a recovering individual feels he or she can prioritise a personal goal. Venues such as education and training centres, sports facilities, colleges, recording studios, voluntary organisations and arts groups are benefiting substantially and financially from motivated people accessing mainstream.  Where individuals are not paying all the costs themselves, there may well be contributions from schemes such as direct payments or from built-in concessions and offers. The increased business generated by mainstream social inclusion is considerable.

Social Inclusion - why it makes sense for businesses

The business case for mental health awareness is evidenced by the increasing numbers of employers who  are commissioning mental health awareness trainings for their workforce.  Employers want trainings which enable their staff to understand more about common mental health conditions.  Understanding mental health means that staff can work better with clients and customers.  It also allows staff to feel less isolated about personal issues around health and well-being. 

Mental health awareness provides the opportunity for employers and employees to find out more about the law as it relates to employment and mental health.

Enlightened employers will seek to develop a workforce team which is happy rather than unhappy, fulfilled rather than excluded.  Courses such as MHFA (Mental Health First Aid) show that attendees often feel that one of the benefits of the training in that it allows for a safe space.  A safe space where individuals can share feelings about their personal well-being in addition to learning about the broader aspects of mental health conditions and the appropriate interventions.

In addition to mental  health, it makes solid sense for businesses to incorporate awareness of social inclusion and mainstream.  Returning to or accessing mainstream living is now a key part of the care pathway for those diagnosed with 'severe and enduring' mental health diagnoses.  It is equally important for people who may be experiencing conditions such as anxiety, phobia or stress at work.

Both groups - those in primary and secondary care - are being signposted to mainstream life rather than to special settings as a central plank of the recovery process.  The implications for any service provider - and that includes businesses - are crucial.  Businesses and services are at the receiving end of mainstream.

Clients in recovery are choosing to access their personal goals through a diverse range of outlets.  These could range from faith venues to volunteer bureaus, from retail outlets to sports centres, from recording studios to adult education colleges, from libraries to personal counselors, from training venues to department stores.

For businesses, it's not just one in four of their staff who may be experiencing mental health challenges, it's also one in four of their clients, customers and service consumers.  Mental health challenges will also have an impact on one in three families.  Disclosed or undisclosed, it's clear that mental health and well-being lie at the heart of our transactions and interactions.

Sunday 2 May 2010

The Business Case for Mental Health Awareness

The Business Case for Mental Health Awareness.  The economic and social cost of mental health problems in the United Kingdom is well documented. In 2002/03 the economic and social cost of mental health problems in England was £77 billion. (SCMH, 2003).  The economic and social cost of mental health problems is greater than that of crime and larger than the total amount spent on all NHS and social services in the UK (HM Treasury, 2005).

Dame Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a major attempt to address these concerns. Legislative review such as the 2005 amendments to the Disability Discrimination Act (DDA) highlighted the need to address the massive economic and social attrition behind issues of mental ill-health. In 2005 the Confederation of British Industry was concerned enough to commission its own research.  Stress, anxiety and depression accounted for a third of the 168 million working days lost in the UK for health and related reasons in 2004, translating to a cost of sickness absence of about £4.1 billion (Confederation of British Industry, 2005).

As a result of legislation, employees have more rights and employers more responsibilities relating to the incidence of mental health in the workplace.  Employees who choose to disclose a mental health condition to their employers are strongly protected by legislation and have the right to 'reasonable adjustments' that they may request their employers to make.  In practice, it is still true that people with mental health diagnoses may well feel little confidence in this legislation.  Nonetheless,  their rights are enshrined in law.  Similarly,  employers have a legal responsibility not to discriminate against employees who have disclosed a mental health condition and to make any reasonable adjustments that have been requested.  




Wednesday 31 March 2010

MHFA England: Local branch of an international movement

Local branch of an international movement

Mental Health First Aid is now running in sixteen countries around the world.  Australia is the birthplace of MHFA.

In 2000, Betty Kitchener and Professor Tony Jorm began writing a MHFA manual and an accompanying course, with the aim to improve the mental health literacy of members of the Australian community. Since then, the MHFA Training and Research Program has been developed, evaluated and disseminated nationally and internationally. This Program includes a 5-day Instructor Training Course to accredit suitable candidates to become MHFA Instructors who deliver the 12-hour MHFA course to their communities. This 12-hour course is designed to give members of the public some skills to help someone developing a mental health problem or in a mental health crisis situation. The philosophy behind the course is that mental health crises, such as suicidal and self-harming actions, may be avoided through early intervention with people developing mental disorders. If crises do arise, then members of the public can take action to reduce the harms that could result.
http://www.mhfa.com.au/

MHFA is revised regularly to keep up-to-date with developments in mental health as well as listening to feedback from course participants and instructors.  One key spin-off of the course (and not originally anticipated) is that people have found it to be a safe and confidential space where personal mental health issues can be shared if they so choose.

In 2008 the Royal Society for Public Health (RSPH) announced support for training and qualifications in Mental Health First Aid. Together with NMHDU (National Mental Health Development Unit) RSPH is developing a national qualification in Mental Health First Aid and is also accrediting the national training programme for the MHFA course instructors.

Saturday 27 March 2010

Mainstream isn't Therapy

Mainstream isn't therapy

Mainstream isn't therapy.  The road back into mainstream life for someone with a 'severe and enduring' mental health diagnosis does not require a therapeutic relationship.  It requires the individual's genuine desire to access the mainstream world based on personal goals, passions and motivation. 

People with mental health conditions are taking the road back to mainstream every day.  Sometimes they achieve this entirely through their own efforts, sometimes with the skills of a bridge builder.  The bridge builder's role is not to set up a therapeutic relationship.  It is simply to help the client identify which area or areas of mainstream life he or she wishes to prioritise.

The most effective way to start the conversation about mainstream is by having the conversation in a mainstream setting.  If a client wishes to access a place where he or she can record and produce music, the meeting can take place in a mainstream music studio.  If a client wishes to access a course in flower arranging, the meeting can be in an adult education venue.  If a client wishes to return to their faith, the meeting can take place in a mosque, temple, church or wherever the client's chosen faith venue happens to be.

The journey of recovery into what Dr. Pat Deegan calls 'valued social roles' can only start effectively by setting out from and within a place where social roles cohere and are realised.  These can be places situated anywhere in the mainstream community and not in special settings.

The client's relationship with the social inclusion bridge builder lasts for as long as the client requests some support in order to access mainstream goals.  As such, it is not an ongoing therapeutic relationship.

Monday 22 March 2010

Broken Recovery II

In a previous post I wrote:

'Dr. Pat Deegan visualises recovery and the return to mainstream life as crucial moments in an individual's journey through mental illness. It is a return that can often be blighted by low expectations, both by the service user and by his or her professional team. Even carers and family members can contribute to damaging an individual's recovery.'

The reasons why a recovery might be 'broken', protracted, delayed, postponed or put on hold indefinitely, are many.  The return to mainstream is part of a crucial moment in the mental health survivor's journey.  The moment is that space where the mental health survivor moves from being a patient into perceiving his or her ability to be a decision-maker.  For Deegan the decision was to refuse the health profession's signposting her to 'a career in mental health'.  Instead she chose to follow an inner calling to become someone who could learn to develop what she calls 'a valued social role'.  The valued social role was to train to become a doctor and to work from the inspirational thought she phrases as 'I am going to become Dr. Deegan and change the mental health system from within so that no-one ever gets hurt in it again.'

Friday 12 March 2010

Access to Mainstream

Access to Mainstream

In a recent editorial, Big Issue magazine founder John Bird states that the purpose of the Big Issue is to enable homeless people to access the marketplace. 

For a homeless person, becoming a Big Issue salesperson creates a position in the marketplace, perhaps for the first time. 

John Bird's explanation of the rationale behind the Big Issue is analagous to the reasons for exclusion from mainstream experienced by many people with mental health conditions. 

As a person who has not only experienced homelessness but who is also a businessman, Bird's prioritises the activities of selling and distribution.  These are methods through which a homeless person can access mainstream.  Bird doesn't discuss breaking down barriers, addressing stigma or seeking support.  He is keen to stress that the purpose of purchasing a Big Issue is not to give charity or even sympathy. The purpose is commercial empowerment for the individual salesperson.

For people with severe and enduring mental health conditions, a similar disempowering process has taken place which not only denies access to the marketplace but to any kind of mainstream opportunity. Sometimes the process has taken place over many years.

A Big Issue seller is a valued salesperson on the basis of their motivation.  He or she becomes a sole trader or franchisee under an umbrella organisation.

For someone with a 'severe and enduring' diagnosis the journey into or back into what Pat Deegan calls a 'valued social role' can be impaired by the same system which has organised support.  Access to mainstream can be discouraged by years of grounding in the process that Deegan calls 'a career in mental health'.

A career in mental health can mean a life on benefits, a life in residential support, a life of incapacity, a career of inertia.  For people with mental health conditions it can be their clinical diagnosis which become the key determinant of  identity.  Yet the factors which determine an active social role for someone with a mental health condition are no different from anyone else's. Our identities are determined by the things we are passionate about, our aspirations, our goals, our dreams and our key priorities.

Meaningful involvement in mainstream for people with a mental health diagnosis begins to take place when individuals are allowed to measure themselves in terms of  their goals. The world of mainstream does not necessarily discriminate or stigmatise and even where it does, this may not be the main obstacle.

Wednesday 3 March 2010

Is anti-stigma the new stigma?

Anti-stigma the new Stigma?

The 'Time to Change' campaign challenges stigma and discrimination against people with mental health conditions.  Time to Change is helping groups and individuals organise activities which actively cooperate in challenging discriminatory attitudes and behaviours.

Challenging discrimination is achieved primarily through engaging in mainstream as a contributor, a consumer or a provider.  Many people with mental health conditions access mainstream activities, making their own choices as to whether to disclose or not.   The greatest impact in challenging mainstream can be achieved by prioritising individual goals and aspirations.  Support is also available  to access mainstream from mental health organisations and bridge builders or through personalisation and direct payments.

'Time to Change' seems to insist that all people with mental health conditions wish to disclose as part of their eligibility for mainstream life.  In a recent campaign video the broadcaster and service user Stephen Fry asserts that stigma and the attitudes of society in general are the main roadblocks that hinder the self-development of people with mental health conditions.

But many individuals with mental health diagnoses are accessing mainstream life without stigma, whether they choose to disclose or not.  Disclosure is really up to the individual and far from discouraging service users to use mainstream, many organisations are open to all and are accessed by people with mental health conditions every day of the week.  These are not  simply voluntary organisations or groups limited to the health or charity sectors.  These are consumer providers of all kinds - art galleries, libraries, recording studios, performance venues, gyms, sports centres, retail outlets and many more.  To assert these these organisations are discriminating simply isn't fair on these groups, nor is it a realistic assessment.

Where people with mental health conditions may lose out is in having the initial confidence to set on the journey back to mainstream.  This is particularly true of those who have been in secondary care and who may have become habituated to the life that Pat Deegan calls 'a career in mental health'.  Dr. Deegan is referring to the lack of  hope, aspiration and goals that can set in with a long-term condition.  

People who play football who happen to have mental health conditions are footballers. They aren't required to be 'positive mental health footballers'.  People who play guitar who happen to have mental health conditions are guitarists, not mental health guitarists.  People who are arts tutors who have a mental health condition are arts tutors.  By continuing to tag mental health on mainstream activities and aspirations there is a danger of recycling stigma and not allowing people to move into valued social roles.

Could anti-stigma be the new stigma?

Monday 1 March 2010

Do Care and Support hinder Recovery?

Care and support are not the only models or frameworks for mental health recovery.  The establishing or re-establishing of what Dr. Pat Deegan refers to as 'valued social roles' can be held back by a mental health system that often encourages the client to choose 'a career in mental health' (Pat Deegan). 

A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life.  A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.

Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions.  So the marginalisation continues.

A genuine return to mainstream can only take place in mainstream.  This is where the role of the bridge builder comes in.  A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself.  It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices.  The amount of support a client may request from there on is determined only by the client not by the bridge builder.

Sunday 28 February 2010

MHPF - Recovery Star Approach

MHPF - Recovery Star Approach

An excellent site about the Recovery Star for social inclusion appears on the Mental Health Providers Forum website.  The link appears on the post header.

Mental Health Providers Forum describes the Recovery Star as:
'a tool for supporting and measuring change when working with adults of working age who are accessing mental health support services. As an outcomes measurement tool it enables organisations to measure and summarise:

the progress being made by service users
the service being delivered through a project.

The Recovery Star is also an effective keyworking tool. It is designed to support individuals in understanding where they are in terms of recovery and the progress they are making, providing both the client and worker a shared language for discussion mental health and wellbeing.

Core dimensions of the Recovery Star
The Recovery Star identifies and measures ten core areas of life:

Managing mental health
Self-care
Living skills
Social networks
Work
Relationships
Addictive behaviour
Responsibilities
Identity and self-esteem
Trust and hope'

Social Inclusion

Social Inclusion

Two major assessment tools have been developed for social inclusion. One is the social inclusion 'Web' and the other is the 'Star' or 'Recovery Star'. The web can be viewed by clicking on the header link above.

Originally created by the National Development Team (NDT) the web is a simple and effective assessment tool based on five key social domains. The domains were identified as key in the research done in the late 90s and early 2000s around social inclusion.

On the web these domains appear as:

Employment
Education & Training
Arts & Culture
Faith & Cultural Communities
Volunteering & Befriending
Family & Neighbourhood
Services

What makes the web unique for mental health is that it does not record or measure symptoms or diagnoses.  A client who wishes to record which services he or she accesses may include the psychiatrist or community mental health team.  However, the main purpose of the web is to record the client's involvement in mainstream.  More importantly, the web is there to identify client's goals and aspirations in terms of where he or she wishes to be in mainstream.

Next blog posting: The Web and the role of the Bridge Builder.

Monday 22 February 2010

Equalities in Mental Health Conference February 24th

Look out for the MHFA England stand at the Equalities in Mental Health Conference on February 24th. Queen Elizabeth II Conference Centre Westminster, London.

Tuesday 16 February 2010

The Broken Recovery

Dr. Pat Deegan visualises recovery and the return to mainstream life as crucial moments in an individual's journey through mental illness.  It is a return that can often be blighted by low expectations, both by the service user and by his or her professional team.  Even carers and family members can contribute to damaging an individual's recovery.

Monday 1 February 2010

Social Inclusion - does it exist?

Social Inclusion has long been a mantra for organisations representing clients who may be isolated or marginalised for one reason or another.  Government think-tanks in the early 2000s identified  key areas or social domains relevant to people's lives and development in the mainstream world.  These are: employment, the arts, spirituality & cultural identity, volunteering, sports & healthy living, family and neighbourhood. 

As a social inclusion bridge builder for mental health, I work with clients who wish to access Arts & Culture .  The social inclusion approach will ask a client to identify which social domains they would like to prioritise for inclusion in mainstream.  The bridge builder's role is then to signpost the client to the mainstream domain which has been prioritised.  In order to facilitate this, bridge builders must have a wide network of local and regional contacts in his or her field of expertise.  Further support relates only to how much or how little the client requests.

As Arts bridge builder for example, I need to know what is out there for clients who may wish to do arts courses or rehearse and record their music.  Other clients may be seeking self-employment through tutoring, performing or composing.  All of these aspirational goals have had successful outcomes, some of them quite outstanding.  All the clients referred to mainstream come from a background of 'severe and enduring' mental health conditions.

The bridge building service is not a clinical or diagnostic one, although we work closely with Community Mental Health Teams.  It is designed to enable clients to participate in mainstream, based on their own preferences, choices, skills and dreams.  Clients are free to choose whether to disclose their illnesses or not. 

When the arts bridge builder meets with a client, the key questions are 'what do you wish to see happen for yourself' or 'what would you like to do'.  Bridge building focuses on aspiration, goals and innate gifts and talents.  And that's it.  

Wednesday 27 January 2010

Severe and Enduring

'Severe and enduring mental health problems' is the category description for people in secondary care in the UK.  The description applies to anyone who's been sectioned or who is under the care of a Community Mental Health Team (CMHT).  People with severe and enduring mental health problems live with their conditions, cope and often recover from their illness.  Not necessarily full recovery  but a return to mainstream life while coping with the longterm condition.

The care provision for secondary or 'severe and enduring' clients is different from the primary care pathway.  Primary care clients are under a GP and have access to psychological therapies such as cognitive behaviour therapy (CBT) and counselling.  Secondary care clients can also receive therapy, but delivered through the Community Mental Health Team and not through GP referral.

Severe and enduring mental health conditions can mean extra limitations for certain clients. Limitations above and beyond the condition itself, barriers on the individual's return to mainstream.   It shouldn't be the case but it is sometimes. At a crucial stage, the recovery path is held back by what amounts to a reinforcement of something that Professor Pat Deegan has described as 'a career in mental health'. 

Current practice around mental health care delivery emphasises as quick a return to mainstream life as is possible and viable.  But the length of time that an individual may have spent in hospitals and under the benefits that are geared to support him or her, can prevent, delay or permanently impair the return to mainstream.  A 'severe and enduring' diagnosis may mean access to appropriate support, but it may also mean a long term stay in the mental health system, supported but cut off from aspiration and opportunity.  This can still be the case after a patient is discharged and living in the community.

Clinical and community teams expend a lot of effort in signposting clients back to mainstream and onto a recovery pathway.  The practical ability to reach for these opportunities may be impaired by a loss of self-worth and empowerment by the time he or she is directed to this part of the care plan.  Clients with severe and enduring conditions may comply in being signposted to mainstream providers because they feel it is required by their teams or because they fear not doing so might lead to losing benefits, not because they have made a genuine individual choice. 

Monday 25 January 2010

Mental Health First Aid as a Commercial Product

MHFA as a Commercial Product

Mental Health First Aid is now running in sixteen countries. It has been updated in line with instructors and trainees' feedback.

As a training course in interventions for common and more serious mental health conditions, MHFA is the only 'first aid' course out there. In the process of full accreditation from the UK's RSPH (Royal Society for Public Health), MHFA is set to become the key industry-standard product in its field.

Employers are required to put in place physical First Aid trainings and trained personnel. Mental Health First Aid will become equally important as a generic workplace health initiative.

MHFA Instructors are trained in marketing their product. Many intructors facilitate MHFA as a self-employed business. A lot of the promotion of MHFA has been and continues to be through established mental health groups and voluntary organisations. Existing staff are trained as MHFA Instructors and seconded to training duties. Often, the courses are heavily subsidised and trainers not paid any more or little more than their existing salaries.

Recommended MHFA Instructor payment rates should strictly speaking, never be less than £35 per hour. This roughly represents the minimum rate that the trainer should be earning for his or her hours of training. For a 12 hour course, this comes to £420 or £210 a day.

The main reason that trainings are being either subsidised and trainers underpaid, is because mental health organisations are not thinking along commercial marketing lines. This is not always the case and another reason is because voluntary organisations may be receiving specific time-limited funding to roll out the trainings.

Eventually, all MHFA courses will have to stand alone without NHS, PCT or other funding. MHFA Instructors who are not already equipped to do so, will have to become proficient at marketing. This does not mean having to charge a vast amount for trainings. It simply means working smart, putting together a budget and business plan designed to enable the course to stand on its feet and make its way in the world.

A commercial mindset for Mental Health First Aid is becoming more and more crucial if the training is to position itself as the generic course of its kind and industry-standard leader in the field.

Thursday 21 January 2010

Social Inclusion for the Artist

As a bridge builder for Arts & Culture, I meet clients with mental health conditions who wish to prioritise their goals for mainstream music, performance, composition, recording, collaboration and promoting. It could be one or all of these areas which a client wishes to work on as a life goal and a key part of his or her recovery.

Although the arts as a life domain has been identified as a highway for individual recovery and inclusion, there are often spin-offs into other areas.

Referral to a mainstream recording studio has led to one client launching a CD of her compositions as well as being commissioned to provide original music for a commercial website. The payments for this alone funded her recording and production sessions. Other clients referred to arts mainstream have gone on to become tutors and trainers in their chosen fields.

Arts as a life domain can not only be a pathway to recovery but also a pathway to employment and/or self-employment. The theraupeutic benefits of the arts have long been recognised - now it's the turn for the arts to be given their fair due as a positive route to work and employment.

myspacemusic.com/johnlvanek

www.crownlanestudio.co.uk