Social Inclusion in south London

Jonny Lang 'Lie to Me'

John Doe no 24 by Mary Chapin Carpenter

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.

The songs of Martin Elliott

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

Peer support workers

A good deal of discussion is taking place around the idea of peer support workers in mental health practice.  A recent Guardian article entitled 'Putting the lunatics in charge of the asylum' has highlighted the debate.

It's not just the 'asylum', hospital, day centre or residential setting where peer support working can take place.  Nor does a peer support or recovery worker have to be an official post, paid or voluntary within the NHS or any clinical setting.

Peer support in mental health is taking place informally all over the place.  Many peer supporters would not even give themselves such a title.  In many cases they are simply spending time with the friends they already know or with the peers who have accessed a setting or venue which attracts them too.

As a bridge builder who has signposted people with severe and enduring mental health diagnoses to mainstream settings of their own choice, I have witnessed this peer support happen over and again.

Four years ago I signposted a client to a mainstream recording studio.  With the help of direct payments he has been accessing this venue weekly ever since, practising guitar and collaborating with others in the studio.  He has also secured part-time employment as a studio assistant, getting the rehearsal rooms ready for bands and bookings.

What has happened as a result of this client's involvement is an informal cascading of peer support and group participation.  Again, this has occurred with very little prompting from the bridge builder.  As my client relishes working with other musicians, he is happy to have peers who also wish to participate i.e. start a band during his weekly studio sessions.  This has resulted in a drummer peer and a singer peer rehearsing regularly together with Bernie (not his real name).  Another peer also attends regularly - a long-term friend of Bernie who is learning guitar from him and who has previously been impossible to place by the bridge building team in any mainstream setting.

This is informal and highly effective peer support.  Above all, it is taking place in mainstream not in any clinical, residential or daycare setting.  Recovery that takes place in mainstream allows for hope, confidence, friendship, group projects and routes to employment.

Music Production course at Crown Lane Studio London

Mainstream - the Cascade Effect

As a social inclusion bridge builder I work with clients with severe and enduring mental health diagnoses. They are referred or they self-refer with the desire to access mainstream life domains.

Clients aspire to a variety of mainstream choices. It might be volunteering or befriending, it may be arts activities, it might be employment or running your own business. Client aspirations may include sports, faith, education, training or a selection from any or all of these.  All drawn from the life domains identified as key by the inclusion think-tanks of the late 90s and early 2000s.  Access to mainstream as a key component of the care pathway.

Enabling individuals with a 'severe and enduring' background is not always a straightforward process although it certainly can be sometimes. A client can be introduced to a mainstream outlet and it can work for him or her almost immediately. Other clients may be unready for mainstream for a variety of reasons. They may suffer a relapse before accessing the mainstream environment. They may visualise mainstream as another form of day service or statutory support system, which it isn't.

Equally, clients can sometimes express a wish to access mainstream out of a misplaced fear that not accessing it might in some way affect their payments and benefits. It can be a long process before the value and rewards of mainstream are understood.

What is true is that clients who successfully access or re-access mainstream in turn become examples of mainstream's effectiveness. Signposting to mainstream as part of the mental health recovery pathway is undoubtedly effective, even if it does not work for everyone straight away.

Mainstream also helps to sustain recovery in the individual and even better, it can propagate more success and recovery out of its own resources. An example of this would be the musician who successfully links up with a mainstream recording studio. After months of regular rehearsal the musician is invited by the studio manager to contribute to a recording session. I witness this kind of beautiful outcome and its benefits for the client in my work as an arts bridge builder.

Another example - again from music bridge building - is the guitarist client who uses a studio regularly and invites a friend to join him during the session. The friend may well be another mental health service user who has never successfully engaged with mainstream despite the best efforts of the bridge building service. Where services have been unsuccessful a friendship and peer network can do the job far more effectively.

Mainstream reaches the places other services cannot reach and in the process it is able to create a cascade effect - a continuing path of development, recovery and individual growth.