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.