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'.
Friday, 10 June 2011
Friday, 3 June 2011
What the heck is person-centred planning?
Person centred planning is a collection of tools and approaches based upon a set of shared values that can be used to plan with a person - not for them . These tools can be used to help the person think about what is important in their lives now and also to think about what would make a good future. Planning should build the person's circle of support and involve all the people who are important in that person's life.
It was developed as a way of enabling people - children and adults - to move out of special segregated places schools, hospital and institutionals into mainstream life - schools and communities.
Person Centred Planning is built on the values of inclusion and looks at what support a person needs to be included and involved in their community. Person centred approaches offer an alternative to traditional types of planning which are based upon the medical model of disability and which are set up to assess need, allocate services and make descisions for people. Person centred planning is rooted in the social model and aims to empower people who have traditionally been disempowered by 'specialist' or segregated services by handing power and control back to them.
For mental health services where the return to mainstream is a key component of the care pathway, person-centred approaches are essential. It's not solely the person-centred approach which is vital but equally, the settings in which those approaches take place. The client who has requested access to a mainstream social domain of their own choosing has every right to be introduced directly to that setting.
A conversation about mainstream access should take place in the appropriate mainstream venue. A client who has requested access to a football group as a player has a right to be introduced to that team.
A client who has requested access to a recording studio for rehearsal his or her music, has the right to be introduced to a mainstream recording studio. A client who has expressed a desire to access a higher or adult education course has the right to be introduced to the venue of their choosing. All of this is entirely in line with the philosophy and practice of mainstream recovery as an 'alternative to traditional types of planning which are based upon the medical model of disability'.
It was developed as a way of enabling people - children and adults - to move out of special segregated places schools, hospital and institutionals into mainstream life - schools and communities.
Person Centred Planning is built on the values of inclusion and looks at what support a person needs to be included and involved in their community. Person centred approaches offer an alternative to traditional types of planning which are based upon the medical model of disability and which are set up to assess need, allocate services and make descisions for people. Person centred planning is rooted in the social model and aims to empower people who have traditionally been disempowered by 'specialist' or segregated services by handing power and control back to them.
For mental health services where the return to mainstream is a key component of the care pathway, person-centred approaches are essential. It's not solely the person-centred approach which is vital but equally, the settings in which those approaches take place. The client who has requested access to a mainstream social domain of their own choosing has every right to be introduced directly to that setting.
A conversation about mainstream access should take place in the appropriate mainstream venue. A client who has requested access to a football group as a player has a right to be introduced to that team.
A client who has requested access to a recording studio for rehearsal his or her music, has the right to be introduced to a mainstream recording studio. A client who has expressed a desire to access a higher or adult education course has the right to be introduced to the venue of their choosing. All of this is entirely in line with the philosophy and practice of mainstream recovery as an 'alternative to traditional types of planning which are based upon the medical model of disability'.
Friday, 22 April 2011
Roadblocks in Mainstream
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. Contrary to some current opinion, it is not stigma from mainstream society that creates the main roadblock.
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. The intention was that this should increase towards full implementation of the personalisation programme. Invididual budgets were scheduled to become the engine for much healthcare practice all over the UK by 2013. However, this is now completely overshadowed and possibly lost permanently, in the thrust towards GP consortia and budget management.
Alongside the sudden disappearance of direct payments is the disappearing access to therapies, both for primary and secondary care patients. Secondary care clients have often lost out in the therapies scenario for a variety of reasons. But clients in primary care are still entitled to a reasonably smooth road to psychological therapies. Entitlement does not ensure that those therapy services are available and in practice these too are disappearing along with personalisation and individual budgets.
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 - anyway those have now dried up. Many activities are free to access or funded by individual clients from their own pockets. Where direct payment has been needed it has often made the crucial difference.
Third-sector organisations also do great work in promoting access to mainstream through a variety of initiatives. 'Emergence' is an arts group run by and for service users who are also visual artists. In London and around the country 'Emergence' has pioneered access to visual arts as well as giving a platform for creativity and exhibition spaces for artists with personality disorder.
'Imagine' in south west London and Surrey also promotes a variety of arts opportunities including music production and visual arts. These are open to service users but take place in mainstream settings.
Mainstream environments have their own health, safety and insurance policies. As a consumer, the service user to entitled to the protection of these policies along with every other mainstream customer and client.
Wednesday, 30 March 2011
Libraries and mental health
Shaun Bailey, an ambassador for the big society project and a former Conservative prospective candidate, has asserted that local councils are closing public libraries because they are "not being used". (Radio 4 'Today 'programme).
Where has he been? Over the last three years local libraries have become a major resource for mental health in the south-west London borough where I work as a bridge builder. The libraries are being used as never before.
As part of the movement to mainstream independence, mental health provider Imagine has moved its day centre services into the local libraries. Not only does this dramatically decrease the marginalisation of people with mental health challenges but it also enables more access for more people. Libraries in their role as community providers have never been more useful and more utilised. The stigma of mental ill-health is itself sidelined when service users access libraries along with the rest of the general public. That's mainstream.
Libraries managers and staff were amongst the first to sign up for mental health awareness training when it was offered in the borough.
I count libraries are amongst the most socially inclusive environments in contemporary community life. My client meetings often take place in the local library. Meeting in a library is one of the best ways to start the conversation about mainstream in a non-clinical setting.
Mainstream can only take place in and from mainstream. Libraries are at the forefront of the practice of inclusion.
Where has he been? Over the last three years local libraries have become a major resource for mental health in the south-west London borough where I work as a bridge builder. The libraries are being used as never before.
As part of the movement to mainstream independence, mental health provider Imagine has moved its day centre services into the local libraries. Not only does this dramatically decrease the marginalisation of people with mental health challenges but it also enables more access for more people. Libraries in their role as community providers have never been more useful and more utilised. The stigma of mental ill-health is itself sidelined when service users access libraries along with the rest of the general public. That's mainstream.
Libraries managers and staff were amongst the first to sign up for mental health awareness training when it was offered in the borough.
I count libraries are amongst the most socially inclusive environments in contemporary community life. My client meetings often take place in the local library. Meeting in a library is one of the best ways to start the conversation about mainstream in a non-clinical setting.
Mainstream can only take place in and from mainstream. Libraries are at the forefront of the practice of inclusion.
Friday, 25 March 2011
Care & support can hinder recovery - revisited
Care and support are not the only models or frameworks for mental health recovery. The establishing or re-establishing of what Dr. Pat Deegan refers to as 'valued social roles' can be held back by a mental health system that often encourages the client to choose 'a career in mental health' (Pat Deegan).
A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.
Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.
Where the retardation of an individual's access to mainstream is most acutely felt often lies conversely in the areas where there is the most 'support'. Nowhere is this more clearly visible than in secondary residential care.
Whereas the main thrust of residential care in mental health is on clients' independence, the system often works to block individual progress. Mental health residential teams expend a lot of effort and do a lot of work encouraging their clients to seek independent opportunities in mainstream life. Unfortunately, the desire to do these activites may not derive from the client him or herself and the contact with mainstream is delayed, deferred or postponed sometimes indefinitely.
Where a client is goaded into mainstream in this way, he or she will sometime be bussed or taxied in to the mainstream venue, accompanied by a key worker. But no amount of buses, taxis or key workers can replace the simple presence of individual personal motivation.
In secondary care, a client's last-minute postponing of the scheduled meeting with mainstream is also commonplace - often postponing three, four or five times. The assumption by services that an able-bodied physically-well individual should need to be accompanied to a local venue by a carer or key worker at all times, seems to me profoundly patronising.
A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client.
A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.
Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.
Where the retardation of an individual's access to mainstream is most acutely felt often lies conversely in the areas where there is the most 'support'. Nowhere is this more clearly visible than in secondary residential care.
Whereas the main thrust of residential care in mental health is on clients' independence, the system often works to block individual progress. Mental health residential teams expend a lot of effort and do a lot of work encouraging their clients to seek independent opportunities in mainstream life. Unfortunately, the desire to do these activites may not derive from the client him or herself and the contact with mainstream is delayed, deferred or postponed sometimes indefinitely.
Where a client is goaded into mainstream in this way, he or she will sometime be bussed or taxied in to the mainstream venue, accompanied by a key worker. But no amount of buses, taxis or key workers can replace the simple presence of individual personal motivation.
In secondary care, a client's last-minute postponing of the scheduled meeting with mainstream is also commonplace - often postponing three, four or five times. The assumption by services that an able-bodied physically-well individual should need to be accompanied to a local venue by a carer or key worker at all times, seems to me profoundly patronising.
A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client.
Friday, 18 March 2011
Clinical and social models of care
In the mental health field, it has long been accepted that clinical and social models of care go hand-in-hand. Doing more than simply addressing clinical symptoms is a requirement of the care pathway.
People who have experienced severe and enduring mental health conditions currently have access to a spectrum of professionals. These range from the psychiatrist, the community mental health nurse, assertive outreach and social workers, O.T.s and other key personnel. Any or all of these individuals can currently form part of the care plan for people recovering from severe mental health conditions. In addition, there is access to third-party groups providing bridge building or similar services. The return to mainstream life based on individual choices forms a strong part of the clinical and social models working together.
So what will be the scenario when mental health moves into the sphere of general practice, along with a host of other clinical services?
In the UK, GP consortia are being set up with the intention of taking over from the primary care teams entirely by the year 2013. The primary care teams that currently incorporate a spectrum of care services for mental health will no longer exist. It is uncertain whether GP consortia and GP surgeries will be equipped to respond to providing the clinical and social models which currently operate for people with 'severe and enduring' diagnoses. What this means is that there could be no access to the key services that are well-positioned to provide access for the individual to his or her independence, recovery and self-development.
The providers who currently enable access to mainstream life for people with mental health conditions will need to introduce themselves to the GP consortia as a matter of urgency. In order to become better placed to continue the work of mainstream recovery it will be important to do this now. Commercial and private providers are already muscling in on the GP consortia and it is unlikely that these groups will have any expertise at all in providing hope and aspiration for marginalised people.
People who have experienced severe and enduring mental health conditions currently have access to a spectrum of professionals. These range from the psychiatrist, the community mental health nurse, assertive outreach and social workers, O.T.s and other key personnel. Any or all of these individuals can currently form part of the care plan for people recovering from severe mental health conditions. In addition, there is access to third-party groups providing bridge building or similar services. The return to mainstream life based on individual choices forms a strong part of the clinical and social models working together.
So what will be the scenario when mental health moves into the sphere of general practice, along with a host of other clinical services?
In the UK, GP consortia are being set up with the intention of taking over from the primary care teams entirely by the year 2013. The primary care teams that currently incorporate a spectrum of care services for mental health will no longer exist. It is uncertain whether GP consortia and GP surgeries will be equipped to respond to providing the clinical and social models which currently operate for people with 'severe and enduring' diagnoses. What this means is that there could be no access to the key services that are well-positioned to provide access for the individual to his or her independence, recovery and self-development.
The providers who currently enable access to mainstream life for people with mental health conditions will need to introduce themselves to the GP consortia as a matter of urgency. In order to become better placed to continue the work of mainstream recovery it will be important to do this now. Commercial and private providers are already muscling in on the GP consortia and it is unlikely that these groups will have any expertise at all in providing hope and aspiration for marginalised people.
Tuesday, 8 March 2011
Friday, 4 March 2011
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.
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.
Saturday, 22 January 2011
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'.
Friday, 7 January 2011
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 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.
Tuesday, 21 December 2010
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.
Friday, 10 December 2010
Mental Health 2010 - Review of the Year 2010 part 1
The background
Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a round-up and reinforcement of the initiatives embodied in the Disability Discrimination Act (DDA), designed to address key concerns around health and legal rights in the workplace.
Major businesses and business organisations have also addressed the massive loss to the economy and to human happiness that can be caused by mental ill-health. In 2005 the Confederation of British Industry was concerned enough to commission its own research. Business owners and directors have not been slow in following the confederation's lead.
The year 2010
Supported by business ‘dragon’ Duncan Bannatyne, Mind’s ‘Taking care of Business’ campaign continues to highlight the initiatives being taken by many employers around issues of mental health at work. Some of the companies who signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.
Anti-stigma group Shift is also 'high visibility' in its tireless campaigning for an end to mental health discrimination and in its promotion of understanding the need to support good mental health in the workplace.
Equality Act
The increasing awareness of how mental health affects us all culminated in 2010 with the Equality Act.
The Act reinforces all the implementations of the Disability Discrimination Act (DDA) and in particular, the rights of employees who have disclosed a mental health condition. Before the act came into force, employees had the legal right to reasonable adjustments in their working conditions where appropriate. With the Equality Act, the burden of proof now lies with the employer to show that adjustments have been made rather than with the employee to prove they haven't. It is a highly significant rights-based change.
Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a round-up and reinforcement of the initiatives embodied in the Disability Discrimination Act (DDA), designed to address key concerns around health and legal rights in the workplace.
Major businesses and business organisations have also addressed the massive loss to the economy and to human happiness that can be caused by mental ill-health. In 2005 the Confederation of British Industry was concerned enough to commission its own research. Business owners and directors have not been slow in following the confederation's lead.
The year 2010
Supported by business ‘dragon’ Duncan Bannatyne, Mind’s ‘Taking care of Business’ campaign continues to highlight the initiatives being taken by many employers around issues of mental health at work. Some of the companies who signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.
Anti-stigma group Shift is also 'high visibility' in its tireless campaigning for an end to mental health discrimination and in its promotion of understanding the need to support good mental health in the workplace.
Equality Act
The increasing awareness of how mental health affects us all culminated in 2010 with the Equality Act.
The Act reinforces all the implementations of the Disability Discrimination Act (DDA) and in particular, the rights of employees who have disclosed a mental health condition. Before the act came into force, employees had the legal right to reasonable adjustments in their working conditions where appropriate. With the Equality Act, the burden of proof now lies with the employer to show that adjustments have been made rather than with the employee to prove they haven't. It is a highly significant rights-based change.
Friday, 26 November 2010
Pat Deegan's Common Ground
Pat Deegan's Common Ground is an impressive new initiative in mental health recovery. Common Ground incorporates goal planning, liaison with GPs and services, person-centred planning and monitoring of medication. Plus a whole lot more.
Wednesday, 17 November 2010
Are UK services ready for direct payments?
Within two years, by 2013, the Personalisation Programme is set to be rolled out across UK health and mental health services.
In June 2010 Eight Primary Care Trusts began roadtesting direct payments for personal health budgets.
'Patients will be offered more choice and control over their healthcare' announced Care Services minister Paul Burstow. 'The launch of the first direct payment scheme is an important step towards putting patients at the heart of everything the NHS does' he added .
The Coalition government has pledged its 'commitment to extend access' to direct payments. As Paul Burstow reasons, direct payments 'is a step away from the rigidity of the Primary Care Trusts deciding what services a patient will receive'.
Quite how the PCTs are going to be less rigid with their budgets is still unclear. Some formidable outcomes have already been achieved in some of the areas where the scheme is being piloted ( testimonial videos on NMHDU website). Nonetheless, the PCTs are still holding the budgets for direct payments.
Where direct payments is not being piloted or simply not understood, patients and carers are still being denied their rights. The 'rigid' approach is still being applied and clients wishing to access mainstream activities of their own choice are being turned down.
The Care Services minister has announced that direct payments 'will stop healthcare from slipping back to the days of one-dimensional, like-it-or-lump-it services'.
It is a great pity and possibly a legal scandal that clients wishing to determine their own recovery journeys are still being turned down by PCTs for direct payments.
'One-dimensional, like-it-or-lump-it services' are still around.
In June 2010 Eight Primary Care Trusts began roadtesting direct payments for personal health budgets.
'Patients will be offered more choice and control over their healthcare' announced Care Services minister Paul Burstow. 'The launch of the first direct payment scheme is an important step towards putting patients at the heart of everything the NHS does' he added .
The Coalition government has pledged its 'commitment to extend access' to direct payments. As Paul Burstow reasons, direct payments 'is a step away from the rigidity of the Primary Care Trusts deciding what services a patient will receive'.
Quite how the PCTs are going to be less rigid with their budgets is still unclear. Some formidable outcomes have already been achieved in some of the areas where the scheme is being piloted ( testimonial videos on NMHDU website). Nonetheless, the PCTs are still holding the budgets for direct payments.
Where direct payments is not being piloted or simply not understood, patients and carers are still being denied their rights. The 'rigid' approach is still being applied and clients wishing to access mainstream activities of their own choice are being turned down.
The Care Services minister has announced that direct payments 'will stop healthcare from slipping back to the days of one-dimensional, like-it-or-lump-it services'.
It is a great pity and possibly a legal scandal that clients wishing to determine their own recovery journeys are still being turned down by PCTs for direct payments.
'One-dimensional, like-it-or-lump-it services' are still around.
Tuesday, 16 November 2010
Do care and support hinder recovery?
Care and support are not the only models or frameworks for mental health recovery. The establishing or re-establishing of what Dr. Pat Deegan refers to as 'valued social roles' can be held back by a mental health system that often encourages the client to choose 'a career in mental health' (Pat Deegan).
A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.
Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.
A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client.
A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.
Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.
A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client.
Wednesday, 10 November 2010
Equality Act 2010
During the parliamentary stages of the Equality Bill, mental health organisation Mind lobbied with other mental health and disability charities to get a ban on pre-employment questionnaires included in the Act. After securing cross-party support for the principle of a ban on questions that ask about a candidate's medical history and putting considerable pressure on Ministers, the last Government introduced a new clause to the Equality Bill making these questions unlawful.
The Equality Act came into force on October 1st 2010. The act bans companies from finding out whether potential employees are healthy enough to work for them prior to an offer of employment. Candidates will no longer be expected to declare medical issues during the recruitment stage unless it is specifically related to their job role.
Equality campaigners have long argued that employers discriminate against prospective employees with mental health issues, disabilities or a long history of illness, putting people off applying for a job.
However, 65pc of employers still ask a candidate about their health prior to a job offer, and 48pc ask potential employees to fill out a questionnaire detailing medical conditions and sickness records, according to a poll of 100 companies by law firm Pannone.
Jim Lister, head of employment law at Pannone, said: "The penalties for employers include investigation by the Equality and Human Rights Commission and the reversal of the burden of proof, meaning that the employer will be assumed to have discriminated, unless it can show there was another reason for non-selection.
Organisations that learn of a person's health issue after the job offer but fail to make reasonable adjustments and are forced to withdraw the offer face litigation, lawyers have said.
The reversal of the burden of proof is highly significant. Effectively this means that an employee who feels discriminated against on the grounds of mental ill-health, for example, is not required to prove that this is the case. It becomes the employer's responsibility to prove that this is not the case. If proved otherwise, the employer will be required by law to comply with equalities legislation and where necessary, to make reasonable adjustments on behalf of the employee.
The Equality Act came into force on October 1st 2010. The act bans companies from finding out whether potential employees are healthy enough to work for them prior to an offer of employment. Candidates will no longer be expected to declare medical issues during the recruitment stage unless it is specifically related to their job role.
Equality campaigners have long argued that employers discriminate against prospective employees with mental health issues, disabilities or a long history of illness, putting people off applying for a job.
However, 65pc of employers still ask a candidate about their health prior to a job offer, and 48pc ask potential employees to fill out a questionnaire detailing medical conditions and sickness records, according to a poll of 100 companies by law firm Pannone.
Jim Lister, head of employment law at Pannone, said: "The penalties for employers include investigation by the Equality and Human Rights Commission and the reversal of the burden of proof, meaning that the employer will be assumed to have discriminated, unless it can show there was another reason for non-selection.
Organisations that learn of a person's health issue after the job offer but fail to make reasonable adjustments and are forced to withdraw the offer face litigation, lawyers have said.
The reversal of the burden of proof is highly significant. Effectively this means that an employee who feels discriminated against on the grounds of mental ill-health, for example, is not required to prove that this is the case. It becomes the employer's responsibility to prove that this is not the case. If proved otherwise, the employer will be required by law to comply with equalities legislation and where necessary, to make reasonable adjustments on behalf of the employee.
Wednesday, 20 October 2010
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
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
Thursday, 26 August 2010
Rachel Perkins Guardian interview August 25th 2010
The phrase "going against the grain" could have been invented for Rachel Perkins. Bring up any contemporary issue surrounding mental health and, chances are, the Mind Champion of the Year will come back with a question about why a particular approach is being taken and then advocate for an alternative.
State benefits, a hot topic, is a case in point. As someone who describes herself as "a child of old Labour", Perkins appears slightly uncomfortable that her views on benefits are in some ways in line with those of the Conservative and Liberal Democrat coalition government. She says she is "torn" by some Conservative plans, such as caps on housing benefit, yet is in agreement with the proposal for "tapering" benefit payments so that people are incentivised to work. "So that every hour that someone works counts," she says.
Equal citizens
She goes on to argue that the focus by some campaigners on defending entitlement to benefits can reinforce the perception that people with mental health difficulties need to be cared for, rather than being thought of as equal citizens. "Instead of talking about the right to work, we are now talking about the right to benefits. I don't think that's terribly healthy," she says.
"Every human being gains their self-worth from being able to contribute to their communities – and let's face it, the most socially sanctioned way to do that is with work."
Perkins, a clinical psychologist, is probably best known for her impressive efforts to get people with mental health problems back into work, and has spearheaded employment programmes at South West London and St George's mental health trust.
Civil rights is at the core of what Perkins advocates, and she raises the topic frequently. Discussions around mental illness should resemble those around physical disability, she says, where the emphasis has been successfully rooted not on impairment but in a "rights-based agenda". In part, her inspiration heralds from a strand of mental health advocacy in the US that promotes a "peer support" approach to recovery and firmly places mental health in the realm of a broader rights agenda.
The difficulty for mental health campaigners in Britain, she suggests, is that they can end up ghettoised when they should be tapping into wide-ranging issues around exclusion. Equally, too many of the messages put out about mental illness are couched in negative terms, she claims. "The mental health movement has spent so long looking inwards at the sort of services people get, not better lives. One of the things I really hated about the mental health world was its aura of doom and gloom. It was always, 'You can't do anything because of stigma and prejudice.' [The] image of possibility often gets lost in the conversation about stigma. I'm not some romantic, but [change] is possible."
In particular, Perkins gives short shrift to anti-stigma campaigns, which have attracted substantial funding in recent years. "I don't have any evidence that they [work]. I prefer not to use the term stigma, because it attaches to the person. We don't talk about the stigma of race. We talk about racism. The problem with anti-stigma campaigns is that they identify the class of people by their impairment," she says. "I want to see some empirical data [that they help people to get] a home and a job. The bottom line [is] I want to change behaviour."
Discrimination
As her long career in the NHS nears its end, one of the themes that Perkins, 55, intends to persevere with is challenging the expectations of the state and employers when it comes to getting people into work and keeping them there. Mental health awareness training is not the answer to discrimination, she insists, adding that it is wrongheaded to demand that employers do the "heavy lifting" for people with mental health problems in the workplace when the state should do more.
When asked in 2009 by the last government to head a review into how to support more people with mental health problems into work, for example, Perkins proposed that employers be given financial compensation by the state to cover some of the cost of long periods of health-related absence.
The ability to work was vital to how Perkins dealt with her own mental health difficulties, which manifested in the early 1990s. But her ambition goes beyond getting people jobs. She wants a transformation in how mental health is perceived. "We've got to look at civil rights in the context of mental health and citizenship, rather than, 'You are a poor unfortunate.' That kind of thing is a hiding to more discrimination."
Spitting people out
Perkins's career path offers some insight into how her views have evolved. She considered going into academia after finishing her PhD but quickly came to the conclusion that research was dull. She applied to train as a clinical psychologist only to find herself rejected as someone who would "wilt" outside the confines of a university. Undeterred, she applied for and got a job as assistant psychologist at Broadmoor, the high security psychiatric institution.
The experience reaffirmed what she instinctively felt: "I've always been concerned about the way our society is very good at spitting people out at the bottom. That's always bothered me."
Clinical training followed, as well as several other jobs, including stints in "the old state bins", the large Victorian asylums that once warehoused patients. Perkins attributes her belief that work is the best route to a better life to those early experiences. She describes one institution she helped close in 1990: "There were 40 beds to a dormitory. There were four baths in every bathroom. It's not a long time ago. They weren't safe places. Far from it. The average stay in that place was 30 years."
Winning the Mind Champion of the Year award last month is particularly special, says Perkins, because it was voted for by the public. Perkins beat household names such as Bill Oddie and Ruby Wax to take the gong. "I think [winning the Mind award] was much nicer than the OBE [awarded in June]," she says. "Being voted for was much better."
Perkins has no intention of easing into retirement and will be taking up consulting roles. "We've got to totally rethink mental health services," she says. "We need to be building up communities to accommodate mental distress and put professionals back in their boxes. I think what we've done is over-professionalise mental health."
Elaborating, Perkins explains that the irony of improvements in mental health service provision over the past 30 or so years – such as closing large asylums, introducing community-based services, and better access to a range of therapies – is that mental illness has been pathologised in a way that unwittingly promotes social exclusion of "a whole class" of people.
"The more we've developed highly sophisticated mental health services, the more, when we experience distress, we think, 'I've got to go to the experts.' Then [our] nearest and dearest think, 'Oh my god, they are not safe in my untrained hands. I've got to leave it to the experts.'"
It's not that mental health professionals aren't important or that therapy, drugs and other kinds of treatment don't have their place, Perkins insists. It is that an over-reliance on them stalls progress. "I'm not opposed to medication [for mental illness]. It's one of the things I use," she says.
What concerns Perkins is that often when trying to improve services – the recent emphasis by politicians and practitioners on "talking therapies", for example – the bigger questions around civil rights, dignity and independence are lost. "I don't believe that psychological therapy solves all ills. The more we translate the entire human process into therapy the more we render ordinary human misery and disturbance to the experts," she says.
Perkins's continued outspoken views on what still needs to change in the mental health arena are likely to ruffle the feathers of her fellow professionals and, if the ideas she promotes are eventually adopted, they could radically alter the way services are delivered
State benefits, a hot topic, is a case in point. As someone who describes herself as "a child of old Labour", Perkins appears slightly uncomfortable that her views on benefits are in some ways in line with those of the Conservative and Liberal Democrat coalition government. She says she is "torn" by some Conservative plans, such as caps on housing benefit, yet is in agreement with the proposal for "tapering" benefit payments so that people are incentivised to work. "So that every hour that someone works counts," she says.
Equal citizens
She goes on to argue that the focus by some campaigners on defending entitlement to benefits can reinforce the perception that people with mental health difficulties need to be cared for, rather than being thought of as equal citizens. "Instead of talking about the right to work, we are now talking about the right to benefits. I don't think that's terribly healthy," she says.
"Every human being gains their self-worth from being able to contribute to their communities – and let's face it, the most socially sanctioned way to do that is with work."
Perkins, a clinical psychologist, is probably best known for her impressive efforts to get people with mental health problems back into work, and has spearheaded employment programmes at South West London and St George's mental health trust.
Civil rights is at the core of what Perkins advocates, and she raises the topic frequently. Discussions around mental illness should resemble those around physical disability, she says, where the emphasis has been successfully rooted not on impairment but in a "rights-based agenda". In part, her inspiration heralds from a strand of mental health advocacy in the US that promotes a "peer support" approach to recovery and firmly places mental health in the realm of a broader rights agenda.
The difficulty for mental health campaigners in Britain, she suggests, is that they can end up ghettoised when they should be tapping into wide-ranging issues around exclusion. Equally, too many of the messages put out about mental illness are couched in negative terms, she claims. "The mental health movement has spent so long looking inwards at the sort of services people get, not better lives. One of the things I really hated about the mental health world was its aura of doom and gloom. It was always, 'You can't do anything because of stigma and prejudice.' [The] image of possibility often gets lost in the conversation about stigma. I'm not some romantic, but [change] is possible."
In particular, Perkins gives short shrift to anti-stigma campaigns, which have attracted substantial funding in recent years. "I don't have any evidence that they [work]. I prefer not to use the term stigma, because it attaches to the person. We don't talk about the stigma of race. We talk about racism. The problem with anti-stigma campaigns is that they identify the class of people by their impairment," she says. "I want to see some empirical data [that they help people to get] a home and a job. The bottom line [is] I want to change behaviour."
Discrimination
As her long career in the NHS nears its end, one of the themes that Perkins, 55, intends to persevere with is challenging the expectations of the state and employers when it comes to getting people into work and keeping them there. Mental health awareness training is not the answer to discrimination, she insists, adding that it is wrongheaded to demand that employers do the "heavy lifting" for people with mental health problems in the workplace when the state should do more.
When asked in 2009 by the last government to head a review into how to support more people with mental health problems into work, for example, Perkins proposed that employers be given financial compensation by the state to cover some of the cost of long periods of health-related absence.
The ability to work was vital to how Perkins dealt with her own mental health difficulties, which manifested in the early 1990s. But her ambition goes beyond getting people jobs. She wants a transformation in how mental health is perceived. "We've got to look at civil rights in the context of mental health and citizenship, rather than, 'You are a poor unfortunate.' That kind of thing is a hiding to more discrimination."
Spitting people out
Perkins's career path offers some insight into how her views have evolved. She considered going into academia after finishing her PhD but quickly came to the conclusion that research was dull. She applied to train as a clinical psychologist only to find herself rejected as someone who would "wilt" outside the confines of a university. Undeterred, she applied for and got a job as assistant psychologist at Broadmoor, the high security psychiatric institution.
The experience reaffirmed what she instinctively felt: "I've always been concerned about the way our society is very good at spitting people out at the bottom. That's always bothered me."
Clinical training followed, as well as several other jobs, including stints in "the old state bins", the large Victorian asylums that once warehoused patients. Perkins attributes her belief that work is the best route to a better life to those early experiences. She describes one institution she helped close in 1990: "There were 40 beds to a dormitory. There were four baths in every bathroom. It's not a long time ago. They weren't safe places. Far from it. The average stay in that place was 30 years."
Winning the Mind Champion of the Year award last month is particularly special, says Perkins, because it was voted for by the public. Perkins beat household names such as Bill Oddie and Ruby Wax to take the gong. "I think [winning the Mind award] was much nicer than the OBE [awarded in June]," she says. "Being voted for was much better."
Perkins has no intention of easing into retirement and will be taking up consulting roles. "We've got to totally rethink mental health services," she says. "We need to be building up communities to accommodate mental distress and put professionals back in their boxes. I think what we've done is over-professionalise mental health."
Elaborating, Perkins explains that the irony of improvements in mental health service provision over the past 30 or so years – such as closing large asylums, introducing community-based services, and better access to a range of therapies – is that mental illness has been pathologised in a way that unwittingly promotes social exclusion of "a whole class" of people.
"The more we've developed highly sophisticated mental health services, the more, when we experience distress, we think, 'I've got to go to the experts.' Then [our] nearest and dearest think, 'Oh my god, they are not safe in my untrained hands. I've got to leave it to the experts.'"
It's not that mental health professionals aren't important or that therapy, drugs and other kinds of treatment don't have their place, Perkins insists. It is that an over-reliance on them stalls progress. "I'm not opposed to medication [for mental illness]. It's one of the things I use," she says.
What concerns Perkins is that often when trying to improve services – the recent emphasis by politicians and practitioners on "talking therapies", for example – the bigger questions around civil rights, dignity and independence are lost. "I don't believe that psychological therapy solves all ills. The more we translate the entire human process into therapy the more we render ordinary human misery and disturbance to the experts," she says.
Perkins's continued outspoken views on what still needs to change in the mental health arena are likely to ruffle the feathers of her fellow professionals and, if the ideas she promotes are eventually adopted, they could radically alter the way services are delivered
Wednesday, 18 August 2010
Recovery news from NHS North West
Manchester Mental Health and Social Care Trust are committed to a recovery approach to mental health care. One element of this is to support service users who want to move into employment. They are currently piloting an Individual Placement and Support (IPS) service, funded by NHS North West.
The project consists of three Employment Specialists, based with Community Mental Health Teams, who help service users to find and remain in employment. The service offers help in preparing for work and engages with both employer and employee to provide ongoing support.
Joanne, one of the service users, is just one of the people to benefit from the pilot so far. After discussing her wish to get back into work with her Community Psychiatric Nurse (CPN) she was referred to the team's Employment Specialist who used the Mental Health Recovery star to talk through Joanne's situation and where she wanted to be in terms of finding a job. They then developed an action plan and the Employment Specialist helped Joanne to find jobs that were suited to her work history and aspirations. Joanne decided that working part time would be the best way to ease back into work life and through regular meetings, the Employment Specialist helped her to explore job vacancies. Eventually they identified one position that suited Joanne in terms of job description, location and number of hours.
The Employment Specialist arranged a meeting with the Disability Employment Adviser at the local Job Centre for support with in-work benefit calculations, and completing a permitted work form with a supporting letter from the Employment Specialist. 10 weeks after engaging with the IPS service, Joanne was successful at securing a Receptionist post for 12 hours a week and stays in touch with her Employment Specialist who provides in work support.
For more information please contact Zeph Curwen, Service Manager Occupational Activity & Employment, zeph.curwen@mhsc.nhs.uk or 0161 720 4809.
For more information on the IPS project contact Lucy Rowe in the Health and Work Programme, Workforce Directorate: lucy.rowe@northwest.nhs.uk or 0161 625 7350.
The project consists of three Employment Specialists, based with Community Mental Health Teams, who help service users to find and remain in employment. The service offers help in preparing for work and engages with both employer and employee to provide ongoing support.
Joanne, one of the service users, is just one of the people to benefit from the pilot so far. After discussing her wish to get back into work with her Community Psychiatric Nurse (CPN) she was referred to the team's Employment Specialist who used the Mental Health Recovery star to talk through Joanne's situation and where she wanted to be in terms of finding a job. They then developed an action plan and the Employment Specialist helped Joanne to find jobs that were suited to her work history and aspirations. Joanne decided that working part time would be the best way to ease back into work life and through regular meetings, the Employment Specialist helped her to explore job vacancies. Eventually they identified one position that suited Joanne in terms of job description, location and number of hours.
The Employment Specialist arranged a meeting with the Disability Employment Adviser at the local Job Centre for support with in-work benefit calculations, and completing a permitted work form with a supporting letter from the Employment Specialist. 10 weeks after engaging with the IPS service, Joanne was successful at securing a Receptionist post for 12 hours a week and stays in touch with her Employment Specialist who provides in work support.
For more information please contact Zeph Curwen, Service Manager Occupational Activity & Employment, zeph.curwen@mhsc.nhs.uk or 0161 720 4809.
For more information on the IPS project contact Lucy Rowe in the Health and Work Programme, Workforce Directorate: lucy.rowe@northwest.nhs.uk or 0161 625 7350.
Tuesday, 17 August 2010
MHFA - crisis intervention
In addition to the umbrella intervention provided by ALGEE (Assess Risk, Listen non-judgementally, Give reassurance, Encourage referral to other agencies, Encourage self-help strategies), MHFA has strong and clear guidelines for crisis intervention. From MHFA:
Crisis First Aid for someone experiencing an acute psychotic episode
Crisis First Aid for someone experiencing an acute psychotic episode
- Do not get involved physically
- Call the police and explain what is happening, unless the person has a mental health crisis card with clear steps describing how you can help.
- Try to create a calm, non-threatening atmosphere.
- Be reassuring, calm and concerned.
- Do not try to reason with someone who is experiencing acute psychosis.
- Express empathy for the person’s emotional distress.
- Comply with reasonable requests
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