The mainstream venue

For many people with a diagnosis of severe and enduring mental ill-health, there is a strong chance of never being employed again.

There are a variety of reasons for this.  Stigma is often put forward as the main block to obtaining work.  Stigma by employers.  Stigma by societal attitudes.  But there is more to it than stigma.

For a significant group of people with mental health conditions, living a life  outside of employment is part of the diagnosis.  Not only diagnosed with clinical illnesses they are also prescribed 'a career in mental health' (Dr. Pat Deegan).

Stigma is only a small part of the rationale behind this exclusion.  Certainly, stigma in employment is still prevalent.  But there are many steps to employment that people may wish to take before they feel ready for work after illness or hospitalisation.  These steps take in any area of aspiration, goals, hopes and dreams that an individual may feel are appropriate. All of these areas once identified should be in mainstream venues.  No-one is going to reach their hopes and goals from a day centre or a clinical setting.

Do mainstream outlets stigmatize against people with mental health conditions?  No, by and large.  Leave out employment where stigma is alive and well.  But elsewhere - in mainstream venues of all kinds stigma is not the issue.

Should people with long-term mental health conditions disclose this to mainstream venues they wish to access?  Only if they personally wish to do so.  It's the individual's choice and no-one should disclose on their behalf.

Someone might feel that disclosure to a mainstream venue might be beneficial or helpful to their progress in that venue.  There may be a key worker or support worker in place.  But the motive behind accessing a mainstream venue is not for 'support' per se.

The motive for a person with a long-term mental health condition to access mainstream is the same as anyone else.  We go to adult education centres to do courses of our choice.  We go to rehearsal studios to play music with our mates.  We go to art galleries to enjoy art.  We go to gyms to do exercise and get fit.  We go to libraries to check out books, use computers and get information.

The person with a mental health condition who accesses these venues is a consumer along with everyone else.  As such he or she is included within the rights of access, protection and insurance that all venues must provide as part of their service.

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.

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.

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).

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