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