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The songs of Martin Elliott

The music of London busker Martin Elliott featured here in his song 'Will you know me?'

Recovery and mainstream

“Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems.”  Shepherd, Boardman and Slade 2008.

There are implications for any mental health recovery programme if it is to take place regardless of  'ongoing symptoms or problems'.  Firstly, it requires that the recovery programme is not determined solely by an individual's clinical diagnosis. Instead, it  must be determined by a person identifying what he or she  needs to build a life that is 'meaningful and satisfying'.

An appropriate service and environment in which this identification can take place needs to be in place to help signpost the journey towards invidual goals and aspirations. Fortunately, there are strategies built in to the care pathway that can enable individuals to identify personal goals and locate the sites in mainstream where hopes and goals can be realised.  Whether these services are commissioned locally and regionally in specific areas is another matter.

It is important that aspirational settings are embedded in mainstream because individual goals are not fulfilled in clinical environments, although they may be identified therein.  It is in mainstream where each and every one of us makes the path to achieving our goals.  Mainstream is where we live, work, learn, create, exercise, develop and grow.  Mainstream venues are the sites where these developments can take place.  Sites that include the arts, sports, education, retailing, volunteering, befriending, family, friends, faith and employment.  It is broadly one or more of these areas that an individual will identify as useful to his or her developmental choices.

When this person-centred practice is backed up by a team that can help direct an individual to the appropriate mainstream setting, then a recovery programme can start in earnest.  It may well be that other settings have helped or continue to help in achieving this - settings such as day services and what used to be referred to as  'sheltered' activities or community projects.  The clinical teams also - assertive outreach, O.T.'s and key workers all contribute to client independence.

It is important that the initial conversation about an individual's mainstream goals and aspirations takes place in a mainstream setting.  This may well be an individual's first re-introduction to the mainstream world after what could have been years of semi-institutional or supported environments.   It is extremely unlikely that the practical hope of achieving mainstream is communicated in a hospital consulting room or even in an individual's own home.  Those areas are associated with support, care and treatment.   Mainstream recovery has to go beyond these boundaries.

So what sort of team can best support an individual when it's not support he or she is requesting but access to goals and self-development?  I would argue that this needs to be provided by a bridge-building team, each member equipped to identify the mainstream venues appropriate to the goals the client has identified.

Mainstream is often achieved indirectly and obliquely.  For example, a client who has identified music as a mainstream goal may not go on to achieve in that field or may change their mind about music as a choice in their recovery.  This can be disappointing for me as arts bridge builder, but it is often the case that these individuals benefit immensely from other aspects of mainstream that the team is able to offer.  I frequently find that some clients who have not engaged through the arts are nonetheless following mainstream goals via the befriending service or through volunteering and sports activities.

Conversely, it can be the case that a client who has been signposted to a music outlet in mainstream, goes on to  achieve goals that go far beyond the initial contact with a music studio or rehearsal room that he or she has requested.  Such clients can and do develop employment and self-employment pathways or go on to further and higher education opportunities.  These goals have been achieved through the initial contact with mainstream and couldn't have been realised any other way.  Mainstream itself will often generate these opportunities for the client independently of the bridge building service.

Because bridge building has the strength to enable an 'oblique' approach, there can be limitless opportunities for motivated clients choosing their recovery pathway.  Even a relapse can only hold up rather than destroy the process.  There are confidence and skill levels that clients develop in mainstream, both from mainstream itself as well as support from peers who accessing the same or similar venues.

Music Production course at Crown Lane Studio London

Obliquity in Mental Health

Formulated by economic theorist and author John Kay, obliquity is the notion that complex goals are often best achieved indirectly. As Kay puts it 'happiness is the product of fulfilment in work and private life, not the repetition of pleasurable actions, so happiness is not achieved by pursuing it'.

Kay is hailed widely as a perceptive business and organisational guru, but his ideas have a great deal of relevance in the mental health field.

Kay is very strong on the question of goals and defining business and personal objectives. However his take is interesting as he does not have a straightforward linear viewpoint.

'We find out about the real nature of our goals in the process of accomplishing them, and our understanding of the complex structures of personal relationships or business organisations is necessarily incomplete', Kay writes.

John Kay underlines the importance of goals and goal-setting, which is commonplace in most business and personal development thinking. But he emphasises that even when we set clear goals, we only 'find out about the real nature of our goals in the process of accomplishing them'.

Nothing could be more true when this perception is applied to mental health, recovery and mainstream.

As a social inclusion bridge builder, I am employed to help enable clients set clear goals and prioritise a personal route into and through the mainstream environment. But even when a client has prioritised one specific pathway, it can sometimes be the case that this will not be the area of mainstream that he or she will end up pursuing.

I have clients who have prioritised music or the arts but who soon find a place elsewhere - in sports, volunteering or employment, for example.

It used to be somewhat discouraging to find that clients were not engaging in their originally prioritised mainstream domains. Now I check with other members of the bridge building team and find that many of my original referrals are now active in other areas.

Obliquity in action!

As John Kay puts it: 'the paradox of obliquity is all around us'.

The role of the bridge builder

Bridge building is a strategy developed in the late 1990s and early 2000s.  Designed to promote social inclusion for groups that might otherwise be marginalised, bridge building has been used to immense effect in the mental health field.  Bridge building is particularly useful for people who suffer or who are in recovery from severe and enduring mental health conditions.

The role of the bridge builder is very simple.  It is to help facilitate access to mainstream environments for individuals, based entirely on their own personal choices.  The original social inclusion think-tanks were set up by the (then) office of the deputy prime minister.  Nine key social domains were identified as key to individual development.  However, it is not expected that every individual would be expected to access every single domain, nor would they wish to.  The key areas include employment, arts & culture, faith and cultural communities, education & training, volunteering, befriending, sports and wellbeing.  There are other domains as well, such as friends and family and statutory services. 

Within these contexts, a bridge building team can be set up, working in mainstream with referrals from other agencies particularly NHS and social services.  It is crucial that the organisation that is commissioned to carry out mainstream is itself embedded in a mainstream environment or conducts its interactions with clients in the big wide world, rather than in a clinical setting.  It is the only way that a conversation with a client about their hopes and aspirations can be realistic and genuine. These approaches are entirely in line with the way mainstream was envisaged as a key part of the care pathway and an alternative to what Dr. Pat Deegan has aptly described as 'a career in mental health'.

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.