The ESA labyrinth

Advocacy for people with mental health conditions is set to become a growth industry for 2012. The Benefits Scandal  by Kaliya Franklin and Sue Marsh shows how benefits for eligible individuals are being made harder and harder to access. A short extract on ESA (Employment Support Allowance) follows:

When it was initially proposed, one of the ideas of the Employment Support Allowance was that disabled and sick people should be helped and supported to work if they wished to do so. 

This was a valid and popular idea. Many sick or disabled people would indeed love to work if there was work that they could do. 


But in its present form the ESA is failing: it simply presents the claimant with a series of dead ends, backed up by a whole raft of sanctions and means tests that negate any realistic chance of success. It takes little account of the limitations of individual conditions, or the barriers to work that someone with a fluctuating or mental health condition may face. 

The capability tests that are applied to claimants are simply unfit for purpose. Currently around 40 per cent of cases go to appeal, and of these 40 per cent succeed in overturning the original decision, a figure that rises to 70 per cent for those with representation. 

Mental health and employment

Mark Brown, editor of One-in-Four magazine has written an excellent feature of mental health and employment.  It is one of the few articles I have come across that speaks common sense on the role of work in mental health recovery.  Mark acknowledges that the journey back into work from secondary or primary care is not straightforward and that employment is not a panacea in itself.  As Mark says:

'For me, the most important thing to remember when discussing work and recovery is that work itself isn’t a magic four letter word; it’s everything that someone gains from being in work that is important'.

Mark Brown is the editor of One in Four magazine
For the full article:
http://www.oneinfourmag.org/index.php/mental-health-and-work-not-a-magic-four-letter-word/

One in Four magazine

One in Four magazine has an excellent article about stigma.  Catherine Amey examines stigma from both sides.  The positive side of mental health stigma being challenged and the less positive side where an over-emphasis on stigma might be harmful for some people.

The One in Four project was conceived by Mark Brown and shaped by his personal experience of mental health difficulty.

The vision was to produce a magazine that inspires people with mental health difficulties to get the best out of life while challenging stereotypes and spreading information that would help everyone to understand mental health difficulty better.

Working with his colleagues at Social Spider CIC Mark developed One in Four as a magazine which approached mental health difficulty in a new way and challenged the stigma that people with mental health difficulties can feel; an aspirational lifestyle magazine covering common life experiences, ambitions and challenges in a way that is readable and relevant to all.

In December 2006, Social Spider secured funding from The Charlie Waller Memorial Trust and South London and Maudsley NHS Foundation Trust Charitable Funds to produce a pilot issue of One in Four to be made available free through community outlets such as GPs’ surgeries, public libraries and places of treatment.

10,000 copies were distributed and the magazine was downloaded 7,000 times from this website – an estimated total readership of around 40,000. Feedback from online and offline surveys and focus groups was overwhelmingly positive with repeated acknowledgement of the magazine’s high production values; 90% said they wanted to read future issues and 75% gave it an approval rating better than 8/10.

As a result of this response, Social Spider has sought funding and developed partnerships and trading activities around the project to enable One in Four to launch as a regular quarterly magazine distributed throughout England.

There is currently no other independent, professionally produced magazine in the UK which is written for people with mental health difficulties and is written by them. Social Spider believes in the potential for One in Four to bring about positive change in the lives of its core audience, their friends, family and carers.

Aside from the money raised through sales of the magazine and other services One in Four is currently supported by Comic Relief, The Charlie Waller Memorial Trust, The South London and Maudsley NHS Foundation Trust Charitable Funds and the Wates Foundation.

Catherine Amey’s book 'Psychosis through My Eyes: A Personal and Professional Journey'  is scheduled to be available as an ebook in September 2011 from Chipmunka Publishing.

Is anti-stigma the new stigma?

The 'Time to Change' campaign challenges stigma and discrimination against people with mental health conditions. Time to Change is helping groups and individuals organise activities which actively cooperate in challenging discriminatory attitudes and behaviours.

Challenging discrimination is achieved primarily through engaging in mainstream as a contributor, a consumer or a provider. Many people with mental health conditions access mainstream activities, making their own choices as to whether to disclose or not. The greatest impact in challenging mainstream can be achieved by prioritising individual goals and aspirations. Support is also available to access mainstream from mental health organisations and bridge builders or through personalisation and direct payments.

'Time to Change' seems to insist that all people with mental health conditions wish to disclose as part of their eligibility for mainstream life. In a recent campaign video the broadcaster and service user Stephen Fry asserts that stigma and the attitudes of society in general are the main roadblocks that hinder the self-development of people with mental health conditions.

But many individuals with mental health diagnoses are accessing mainstream life without stigma, whether they choose to disclose or not. Disclosure is really up to the individual and far from discouraging service users to use mainstream, many organisations are open to all and are accessed by people with mental health conditions every day of the week. These are not simply voluntary organisations or groups limited to the health or charity sectors. These are consumer providers of all kinds - art galleries, libraries, recording studios, performance venues, gyms, sports centres, retail outlets and many more. To assert these these organisations are discriminating simply isn't fair on these groups, nor is it a realistic assessment.

Where people with mental health conditions may lose out is in having the initial confidence to set on the journey back to mainstream. This is particularly true of those who have been in secondary care and who may have become habituated to the life that Pat Deegan calls 'a career in mental health'. Dr. Deegan is referring to the lack of hope, aspiration and goals that can set in with hospitalisation or a long-term condition.

People who play football who happen to have mental health conditions are footballers. They aren't required to be 'positive mental health footballers'. People who play guitar who happen to have mental health conditions are guitarists, not mental health guitarists. People who are arts tutors who have a mental health condition are arts tutors. By continuing to tag mental health on mainstream activities and aspirations there is a danger of recycling stigma and not allowing people to move into valued social roles.

Could anti-stigma be the new stigma?

Ian Springham - Portrait of a talented artist

One of the great pluses of working for a mainstream organisation like 'Imagine' is the opportunity it gives to meet and work with a diverse range of talented people.  The artist and painter Ian Springham has tutored in mixed media for Imagine.  He also co-organised an exhibition at Wimbledon Library gallery.  This is Ian's story:

'In my 30s, I experienced a series of breakdowns far beyond anything thitherto experienced. It felt as though the entire Universe had exploded, the echoes of which long reverberated in my psyche.

Whilst trying to find appropriate help, I had to deal with an ever-more bewildering set of diagnoses, as I revealed more of my inner world. My labelling starting with Panic Disorder and went through to Borderline Personality Disorder and beyond ..

Despite this admirable list, there seemed to be little means of help available and whilst awaiting therapy, as well as researching and joining groups online such as BorderlineUK and PersonalityPlus, I joined the Service Users Network. However, what I really needed was one-on-one psychotherapy. After incessant badgering from my wife, 13 psychotherapeutic sessions became available. Despite confirming many of my worst fears, they were over before I could start to stuff the released demons back into their respective bottles.

Further pressures from my wife brought about a 40-week series of sessions with an esteemed psychotherapist - such was the complexity of the presenting disorders. Having reached a greater understanding and acceptance of myself, there also being no more therapy available on the NHS, I set upon a haphazard course through Alcoholics Anonymous, Croydon College, and Merton Adult Education’s art classes for people similarly troubled.

There was no stopping me. I blossomed through art and Imagine Mental Health eventually invited me to run their art sessions. This was the outwardly visible start of rebuilding my life, as I found I could use my previously untapped empathy and experiences to help others. Classes and exhibitions of artwork followed, giving confidence in both mine and others’ recovery. Finally I’d found a way through.

Later the MACS drug & alcohol project further extended belief in my artistic and mentoring skills, and lead to me volunteering for the online forum that Rethink Mental Illness provides. I put longstanding IT skills and online experience developed as coping mechanisms, to better and wider use. RethinkTalk is an online community for everyone affected by severe mental illness to exchange ideas, opinions, artwork, and support. My roles there as moderator, guide, advocate, activist, friend, mordant artist, and occasional wit, have hopefully also helped others explore their situations in a safer, more supportive environment.'
Ian Springham

Exposure to mainstream life

Mental health service users who live in residential care settings are often in danger of never being able to realise mainstream goals.  For various reasons it turns out that the initial exposure to mainstream life is the key factor in determining an individual's further progress into that milieu.

Residential care covers a range of bases.  It could be a residential home or a family setting, even the setting of a marriage or a personal relationship.  Carers and support workers do not always have their charges' independence as a key priority.  Sometimes carers or family members derive more support for themselves by living or being with the 'cared-for' member than vice versa.  Even staff within the clinical teams are often geared to providing support at the expense of encouraging mainstream development. What this can lead to is a form of unnecessary and intrusive over-protectiveness.

The results of enabling people to access mainstream are frequently nothing short of amazing. When this access is based entirely on clients' own choices the results can become formidable.    

Obliquity and 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'.

No symptoms, no problems

“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.

Regular readers of this blog will know that I am an arts and faith bridge builder based in south London. Readers will also know that I work directly with people referred from secondary care, that is people with what are called 'severe and enduring' mental health diagnoses. I work with colleagues who are all trained in identifying the mainstream areas appropriate to their bridge building roles. The employment advisor must know about mainstream employment, the sports bridge builder about sports venues, the arts bridge builder must know about the arts locally and regionally.

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. The confidence and skill levels that clients develop in mainstream enhance growth into further mainstream activities and domains.

Imagine Mainstream studio collaboration at Crown Lane Morden

Mainstream in 2012

The future of the mainstream approach in mental health recovery is bleak.  Once pioneered as the most radical yet realistic approach to the care pathway, mainstream has now been side-lined and pushed into a corner.

The thinking behind mainstream in mental health is simple.  Linking up individuals with mainstream areas of their own choice as part of recovery.  These areas or 'social domains' cover a wide spectrum: the arts, employment, volunteering, sport and healthy living, faith, worship or spirituality, employment, self-employment, education and business.

In 2012, the cuts in mental health provision are deep and across the board.  Employment is touted as a be-all and end-all yet employment often only happens through a gradual re-introduction to mainstream living .  This is especially true for people who are in secondary mental health care with a diagnosis of 'severe and enduring' conditions.

The outcomes that have been attained by individuals who have been referred or self-referred to a mainstream service are often formidable.  Access to mainstream arts providers such as music recording studios, visual arts courses or creative writing workshops have led to individuals succeeding in employment, self-employment, higher education and collaborative enterprises with their peers.

The mainstream approach goes far beyond therapies and this blog contains many examples of its success.

Mainstream is based on recovery as opposed a 'cure'.  It is also based on the individual claiming his or her right to mainstream living along with everyone else.

The opportunity to access mainstream on his or her own terms is not denied to an individual with a 'severe and enduring' mental health diagnosis. Mainstream can be highly supportive of clients' individual aspirations and self-development. Sometimes this encouragement comes directly from the mainstream outlet itself rather than being dictated by carers, statutory services or voluntary agencies. What can be denied and often is, is the opportunity to access the opportunities in the first place.

In many cases, an individual with a 'severe and enduring' mental health diagnosis will only have the chance to access a mainstream activity if it is built in to his or her care pathway and recovery plan.  The professionals who can help signpost people to such activities will be skilled in allowing individuals to identify personal goals and aspirations.  They will also need skills in knowing exactly where the mainstream sites are where an individual can develop and pursue his or her aspirations.   Linking someone up with a mainstream activity of his or her own choice allows that mainstream venue to provide exactly what it is already providing for its clients, users and consumers. 

The client with a mental health diagnosis will be treated no differently from anyone else, unless he or she has specificied particular adjustments.  That too is part of person-centred planning, with individuals free to disclose or not as they deem fit.

There are sound reasons for mainstream being a lot less discriminatory and stigmatizing than it can be portrayed. Mainstream allows individuals to access services as consumers with consumer rights. If someone with a mental health diagnosis freely chooses to develop his or her aspirations in a mainstream environment, there is no good reason why that person should be denied any of the services that particular venue may provide. The client is accessing mainstream as a consumer of that service, not as a 'diagnosis'.

Once a firm relationship with mainstream has been established, there are multiple ways that mainstream finds to continue to develop individual hopes, dreams and aspirations. I have clients who have found employment through accessing music by rehearsing regularly in a mainstream recording studio. Others have opted to join higher and further education outlets to progress with their dream. Yet others have become volunteers in an environment they enjoy. This has not happened because I have requested the venue to provide employment for my clients Far from it - the venue itself often instigates the process or helps provide the signposting. In many cases this can lead an individual towards a working role in the environment where he or she happens to feel most fulfilled.

This is the viral effect of mainstream

John sings original song 'Revival Day' live at London's Jamboree Club

A Career in Mental Health?

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 life coach or 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 not by the life coach.

Music production in mainstream

Music production courses in Morden London are enabling Imagine clients to make a return to mainstream life through things they feel passionate about.

John Vanek sings William Blake 'Hear the Voice of the Bard'

Building a meaningful life

“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.

Regular readers of this blog will know that I am an arts and faith bridge builder based in south London.

Readers will also know that I work directly with people referred from secondary care, that is people with what are called 'severe and enduring' mental health diagnoses.  I work with colleagues who are all trained in identifying the mainstream areas appropriate to their bridge building roles.  The employment advisor must know about mainstream employment, the sports bridge builder about sports venues, the arts bridge builder must know about the arts locally and regionally.

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 that will stand them in good stead.

Music Production course at Crown Lane Studio London

The viral effect of mainstream

Things can happen when a client with a mental health condition is allowed the opportunity to access mainstream on his or her own terms. Mainstream can be highly supportive of clients' individual aspirations and self-development. Sometimes this encouragement comes directly from the mainstream outlet itself rather than being dictated by carers, statutory services or voluntary agencies. 

There are sound reasons for this.  Mainstream allows individuals to access services as consumers with consumer rights.  If someone with a mental health diagnosis freely chooses to develop his or her aspirations in a mainstream environment, there is no good reason why that person should be denied any of the services that particular venue may provide.  The client is accessing mainstream as a consumer of that service, not as a 'diagnosis'. 

Once a firm relationship with mainstream has been established, there are multiple ways that mainstream finds to continue to develop individual hopes, dreams and aspirations.  I have clients who have found employment through accessing music by rehearsing regularly in a mainstream recording studio.  Others have opted to join higher and further education outlets to progress with their dream.  Yet others have become volunteers in an environment they enjoy. This has not happened because I have requested the venue to provide employment for my clients  Far from it, the venue itself often instigates the process or helps provide the signposting.   In many cases this can lead an individual towards a working role in the environment where he or she happens to feel most fulfilled.

This is the viral effect of mainstream

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'.

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'.