Shaun Bailey, an ambassador for the big society project and a former Conservative prospective candidate, has asserted that local councils are closing public libraries because they are "not being used". (Radio 4 'Today 'programme).
Where has he been? Over the last three years local libraries have become a major resource for mental health in the south-west London borough where I work as a bridge builder. The libraries are being used as never before.
As part of the movement to mainstream independence, mental health provider Imagine has moved its day centre services into the local libraries. Not only does this dramatically decrease the marginalisation of people with mental health challenges but it also enables more access for more people. Libraries in their role as community providers have never been more useful and more utilised. The stigma of mental ill-health is itself sidelined when service users access libraries along with the rest of the general public. That's mainstream.
Libraries managers and staff were amongst the first to sign up for mental health awareness training when it was offered in the borough.
I count libraries are amongst the most socially inclusive environments in contemporary community life. My client meetings often take place in the local library. Meeting in a library is one of the best ways to start the conversation about mainstream in a non-clinical setting.
Mainstream can only take place in and from mainstream. Libraries are at the forefront of the practice of inclusion.
Wednesday 30 March 2011
Friday 25 March 2011
Care & support can hinder recovery - revisited
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.
Where the retardation of an individual's access to mainstream is most acutely felt often lies conversely in the areas where there is the most 'support'. Nowhere is this more clearly visible than in secondary residential care.
Whereas the main thrust of residential care in mental health is on clients' independence, the system often works to block individual progress. Mental health residential teams expend a lot of effort and do a lot of work encouraging their clients to seek independent opportunities in mainstream life. Unfortunately, the desire to do these activites may not derive from the client him or herself and the contact with mainstream is delayed, deferred or postponed sometimes indefinitely.
Where a client is goaded into mainstream in this way, he or she will sometime be bussed or taxied in to the mainstream venue, accompanied by a key worker. But no amount of buses, taxis or key workers can replace the simple presence of individual personal motivation.
In secondary care, a client's last-minute postponing of the scheduled meeting with mainstream is also commonplace - often postponing three, four or five times. The assumption by services that an able-bodied physically-well individual should need to be accompanied to a local venue by a carer or key worker at all times, seems to me profoundly patronising.
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.
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.
Where the retardation of an individual's access to mainstream is most acutely felt often lies conversely in the areas where there is the most 'support'. Nowhere is this more clearly visible than in secondary residential care.
Whereas the main thrust of residential care in mental health is on clients' independence, the system often works to block individual progress. Mental health residential teams expend a lot of effort and do a lot of work encouraging their clients to seek independent opportunities in mainstream life. Unfortunately, the desire to do these activites may not derive from the client him or herself and the contact with mainstream is delayed, deferred or postponed sometimes indefinitely.
Where a client is goaded into mainstream in this way, he or she will sometime be bussed or taxied in to the mainstream venue, accompanied by a key worker. But no amount of buses, taxis or key workers can replace the simple presence of individual personal motivation.
In secondary care, a client's last-minute postponing of the scheduled meeting with mainstream is also commonplace - often postponing three, four or five times. The assumption by services that an able-bodied physically-well individual should need to be accompanied to a local venue by a carer or key worker at all times, seems to me profoundly patronising.
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.
Friday 18 March 2011
Clinical and social models of care
In the mental health field, it has long been accepted that clinical and social models of care go hand-in-hand. Doing more than simply addressing clinical symptoms is a requirement of the care pathway.
People who have experienced severe and enduring mental health conditions currently have access to a spectrum of professionals. These range from the psychiatrist, the community mental health nurse, assertive outreach and social workers, O.T.s and other key personnel. Any or all of these individuals can currently form part of the care plan for people recovering from severe mental health conditions. In addition, there is access to third-party groups providing bridge building or similar services. The return to mainstream life based on individual choices forms a strong part of the clinical and social models working together.
So what will be the scenario when mental health moves into the sphere of general practice, along with a host of other clinical services?
In the UK, GP consortia are being set up with the intention of taking over from the primary care teams entirely by the year 2013. The primary care teams that currently incorporate a spectrum of care services for mental health will no longer exist. It is uncertain whether GP consortia and GP surgeries will be equipped to respond to providing the clinical and social models which currently operate for people with 'severe and enduring' diagnoses. What this means is that there could be no access to the key services that are well-positioned to provide access for the individual to his or her independence, recovery and self-development.
The providers who currently enable access to mainstream life for people with mental health conditions will need to introduce themselves to the GP consortia as a matter of urgency. In order to become better placed to continue the work of mainstream recovery it will be important to do this now. Commercial and private providers are already muscling in on the GP consortia and it is unlikely that these groups will have any expertise at all in providing hope and aspiration for marginalised people.
People who have experienced severe and enduring mental health conditions currently have access to a spectrum of professionals. These range from the psychiatrist, the community mental health nurse, assertive outreach and social workers, O.T.s and other key personnel. Any or all of these individuals can currently form part of the care plan for people recovering from severe mental health conditions. In addition, there is access to third-party groups providing bridge building or similar services. The return to mainstream life based on individual choices forms a strong part of the clinical and social models working together.
So what will be the scenario when mental health moves into the sphere of general practice, along with a host of other clinical services?
In the UK, GP consortia are being set up with the intention of taking over from the primary care teams entirely by the year 2013. The primary care teams that currently incorporate a spectrum of care services for mental health will no longer exist. It is uncertain whether GP consortia and GP surgeries will be equipped to respond to providing the clinical and social models which currently operate for people with 'severe and enduring' diagnoses. What this means is that there could be no access to the key services that are well-positioned to provide access for the individual to his or her independence, recovery and self-development.
The providers who currently enable access to mainstream life for people with mental health conditions will need to introduce themselves to the GP consortia as a matter of urgency. In order to become better placed to continue the work of mainstream recovery it will be important to do this now. Commercial and private providers are already muscling in on the GP consortia and it is unlikely that these groups will have any expertise at all in providing hope and aspiration for marginalised people.
Tuesday 8 March 2011
Friday 4 March 2011
What does Pat Deegan mean by a 'career in mental health'?
When Dr. Pat Deegan coined the phrase 'a career in mental health' she was referring to endemic features of the mental health system prevailing at the time when she was first clincially diagnosed. A 'career in mental health' was the path that her specialists advised would become her future. It would mean a life on benefits, no chance of employment and massively limited access to opportunities. It would mean an end to her aspirations, and end to her hopes. Effectively, the end of a career.
For people who have been through secondary mental health experiences in the UK, a 'career in mental health' can still be the norm. Huge inroads have been made nonetheless. The recovery programmes that have been set up by many clinical teams all around the country. The user-led services that are widely encouraged and supported. The involvement in recruiting people who have experienced mental health conditions for employment within services. The movement from supported accommodation to independent living. The emphasis on mainstream by third-sector organisations working alongside the NHS and statutory services. The 'paths to personalisation' programme and the independence-based use of direct payments and personal budgets.
These initiatives and more continue to help enable people with severe and enduring diagnoses to find personal autonomy and make a break from the pitifully bleak reality of Deegan's appositely-described 'career in mental health'.
But what of the future?
In the UK we are witnessing the root-and-branch dismantling of mental health services as they currently stand. There will be no more primary care teams and more and more people are being discharged from CMHTs (Community Mental Health Teams). Within two years consortia of GPs and general practice surgeries will become the budget-holders both for primary and secondary mental health care.
At this stage there is no way of telling whether these changes will be for the better or for the worse. The only implacable fact is change itself, massive and across the board.
The fallout from the first tremors of change is already with us. The much-vaunted personalisation programme was due to be rolled out universally throughout the UK within 18 months. Now it is unlikely to happen at all. Personal budgets could well be forgotten in the midst of the general upheaval of services. Certainly, direct payments for mental health have become a thing of the past, at least in the south-west London borough where I work as a bridge builder. This is despite service users having a legal right to direct payments where these can be shown to be a strong factor in their recoveries.
The experience of personalisation in other parts of the UK may well be different and could paint a much more hopeful picture. Unfortunately, in the tsunami of change it won't last.
For people who have been through secondary mental health experiences in the UK, a 'career in mental health' can still be the norm. Huge inroads have been made nonetheless. The recovery programmes that have been set up by many clinical teams all around the country. The user-led services that are widely encouraged and supported. The involvement in recruiting people who have experienced mental health conditions for employment within services. The movement from supported accommodation to independent living. The emphasis on mainstream by third-sector organisations working alongside the NHS and statutory services. The 'paths to personalisation' programme and the independence-based use of direct payments and personal budgets.
These initiatives and more continue to help enable people with severe and enduring diagnoses to find personal autonomy and make a break from the pitifully bleak reality of Deegan's appositely-described 'career in mental health'.
But what of the future?
In the UK we are witnessing the root-and-branch dismantling of mental health services as they currently stand. There will be no more primary care teams and more and more people are being discharged from CMHTs (Community Mental Health Teams). Within two years consortia of GPs and general practice surgeries will become the budget-holders both for primary and secondary mental health care.
At this stage there is no way of telling whether these changes will be for the better or for the worse. The only implacable fact is change itself, massive and across the board.
The fallout from the first tremors of change is already with us. The much-vaunted personalisation programme was due to be rolled out universally throughout the UK within 18 months. Now it is unlikely to happen at all. Personal budgets could well be forgotten in the midst of the general upheaval of services. Certainly, direct payments for mental health have become a thing of the past, at least in the south-west London borough where I work as a bridge builder. This is despite service users having a legal right to direct payments where these can be shown to be a strong factor in their recoveries.
The experience of personalisation in other parts of the UK may well be different and could paint a much more hopeful picture. Unfortunately, in the tsunami of change it won't last.
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