Friday 30 July 2010

Derbyshire's personalisation champion

Personalisation, individual budgets, direct payments have all been around for some time.  The particular significance for mental health and recovery is highlighted by some of the action that has been taken by service users. 

Tony Martin has been speaking up for people with mental health problems since he started using services 15 years ago. In 2006 he took up a direct payment and became a convert to personalisation.

When the Department of Health started piloting individual budgets in 2005, he was appointed as a citizen leader tasked with promoting self-directed support.

Becoming a Mind personalisation champion was an extension of what he was doing already, though the cachet of saying he was working for Mind helped open more doors.

Martin aimed to increase the number of mental health service users with a direct payment in Derbyshire. As champion, he used his established links with the local primary care trust, the county council, government and with service users and service user forums.

He even held a conference on personal budgets to disseminate thinking. Attended by 140 people, including professionals, carers and service users, all groups felt they had learned a great deal.

Tackling professionals' attitudes and levels of knowledge about personalisation was key.

Martin says: "The real crux of it is ignorance in the service teams about how a direct payment can be used differently in mental health compared with in other groups, such as people with disabilities.

"It's no good thinking about how you can get people out of bed. It's about being able to give us new focuses and new interests in life and improving our quality of life."

Martin's analysis of 'ignorance in the service teams' is probably no longer as relevant as it was when he made the original comment.  Mental health teams are very clued-in with the importance of direct payments as a potential route to mainstream above and beyond simple arrangements for care provision. 

Service users like Martin and user groups are also pioneering creative uses for direct payments.  Also, independent brokers working alongside mental health teams can help to ensure that direct payments and personalisation go hand-in-hand.  Ultimately, personalisation can only exist for the sole purpose of enabling individuals' dreams, hopes and aspirations in the mainstream world.

Tony Martin's championing of direct payments for mental health led to a dramatic increase in take-up.  By March 2010 there were 52 mental health service users with a direct payment in Derbyshire, up from 16 in September 2009, when Martin started his work as a champion.

Pat Deegan on youtube

Tuesday 27 July 2010

Bridge Building for Mainstream

Bridge building for mainstream is now incorporated into the care pathway for people recovering from mental health conditions.

Community mental health teams, occupational therapies, psychiatrists are all aware of the value of mainstream bridge building. Many community mental health teams actively promote mainstream as part of their in-house practice with clients. Service-user led initiatives are also widely encouraged.

Where mental health teams may not always the time and resources to promote mainstream fully, there are many outside organisations working alongside the teams. The benefits of referral to an outside non-clinical team can be considerable.

Mental health teams can often discuss mainstream with clients in a clinical or home setting. An outside organisation has more time and capacity to draw clients out into mainstream settings where a conversation can begin. This may well be and should be - a conversation about the client's hopes, dreams, goals and aspirations.

One of the bridge builder's roles is to help facilitate this conversation. Another role is to be clued-in with what mainstream has to offer. For example, a bridge builder specialising in arts and culture needs to know what outlets there are both locally and further afield. A client who wishes to develop skills in music production should be introduced to the mainstream venue or venues where this opportunity takes place.

Sunday 25 July 2010

Mainstream - the Cascade Effect

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

Clients aspire to a variety of mainstream choices. It might be volunteering or befriending, it may be arts activities, it might be employment or running your own business. Client aspirations may include sports, faith, education, training or a selection from any or all of these.

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

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

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

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

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

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

Thursday 22 July 2010

Traditional cohorts

Service providers, staff, service users and carers are often perceived as the main groups comprising the traditional cohort of secondary mental health care provision. All this changes when mainstream practice is incorporated into care pathways. The effect of mainstreaming is that it introduces new stakeholders into the equation. Stakeholders chosen by the client as part of his or her recovery. Person-centred practice is designed to enable the person in recovery to access activities and outlets of their own choice in the mainstream environment. These outlets can be anywhere and everywhere, depending on the client's personal goals, hopes and aspirations.

Mainstream effectively destroys the stigma attached to recovery as it is longer attached to special settings, wherever this is the individual's preferred choice.

Monday 19 July 2010

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Thursday 15 July 2010

Discussing Mainstream

Bridge building for mainstream is now incorporated into the care pathway for people recovering from mental health conditions.

Community mental health teams, occupational therapies, psychiatrists are all aware of the value of mainstream bridge building. Many community mental health teams actively promote mainstream as part of their in-house practice with clients. Service-user led initiatives are also widely encouraged.

Where mental health teams may not always the time and resources to promote mainstream fully, there are many outside organisations working alongside the teams. The benefits of referral to an outside non-clinical team can be considerable.

Mental health teams can often discuss mainstream with clients in a clinical or home setting. An outside organisation has more time and capacity to draw clients out into mainstream settings where a conversation can begin. This may well be and should be - a conversation about the client's hopes, dreams, goals and aspirations.

One of the bridge builder's roles is to help facilitate this conversation. Another role is to be clued-in with what mainstream has to offer. For example, a bridge builder specialising in arts and culture needs to know what outlets there are both locally and further afield. A client who wishes to develop skills in music production should be introduced to the mainstream venue or venues where this opportunity takes place.

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Wednesday 14 July 2010

Mainstream and the law

The Disability Discrimination Act (DDA 2005) makes it unlawful for a service provider to discriminate against a disabled person by refusing to provide any service which it provides to members of the public.”

'Service provider' refers to public and commercial sectors alike. A service provider may be a retail outlet, an NHS service, an employment bureau, a police station, a dating agency....the list is endless.

The implications for mainstream are highly significant. Clients referred from backgrounds of mental ill-health to mainstream life will encounter a new range of service providers. It is a social inclusion bridge builder's role to ensure that clients accessing mainstream are introduced to any service providers the client may have identified as key. Once a client is engaging with the services or products of that provider, he or she will be a beneficiary of the policies, procedures, insurance and legal obligations of that provider. The service user becomes equal with all the other consumers who are accessing mainstream as a matter of course. Consumers' rights are considerable.

Another result of the mainstream process is that it puts the responsibility for provision onto the mainstream provider. A client accessing a mainstream service such as a recording studio, for example, is a beneficiary of all that the studio provides. Provides not merely in terms of the studio service and products, but also in terms of the studio's policies, procedures, insurance and legal obligations. Equality with every other consumer creates an equal opportunities situation for the person now accessing mainstream.

Mainstream is not required to provide 'special settings' and nor should it. Mainstream should not stigmatize because of its awareness or unawareness of mental health issues. It should not stigmatize because stigma is not part of any reasonable access to a mainstream product or service.

Tuesday 13 July 2010

History of Social Inclusion

Social Inclusion and mainstream arise out of a history and out of a history of ideas.

Government think-tanks in the late 1990s and early 2000s had a key role in developing current thinking and practice around social inclusion. The envisaging of 'social domains' relevant to people's lives arises from these seminal ideas. The role of mainstream bridge builder is also developed around the concept of mainstream as a pathway for mental health recovery.

Social Inclusion goes back even further. A single act of defiance by Rosa Parks in 1955 in Alabama Mississippi. A black woman refusing to give up her seat on the bus to a white person, thereby defying the segregration laws. A key moment that lies at the heart of the civil rights movement, not just for the United States but for equality and social inclusion everywhere.

Equal opportunities, diversity, social inclusion and fairness are now commonplaces, enshrined in the way we strive to live and work today.

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Monday 12 July 2010

Tools for Social Inclusion

Two major assessment tools have been developed for social inclusion. One is the social inclusion 'Web' and the other is the 'Star' or 'Recovery Star'.

Originally created by the National Development Team (NDT) the web is a simple and effective assessment tool based on five key social domains. The domains were identified as key in the research done in the late 90s and early 2000s around social inclusion.

On the web these domains appear as:

Employment
Education & Training
Arts & Culture
Faith & Cultural Communities
Volunteering & Befriending
Family & Neighbourhood
Services

What makes the web unique for mental health is that it does not record or measure symptoms or diagnoses. A client who wishes to record which services he or she accesses may include the psychiatrist or community mental health team. However, the main purpose of the web is to record the client's involvement in mainstream. More importantly, the web is there to identify client's goals and aspirations in terms of where he or she wishes to be in mainstream.

Sunday 11 July 2010

Social Inclusion - the mantra and the tantra

Social Inclusion - Does it exist?

Social Inclusion has long been a mantra for organisations representing clients who may be isolated or marginalised for one reason or another. Government think-tanks in the early 2000s identified key areas or social domains relevant to people's lives and development in the mainstream world. These are: employment, the arts, spirituality & cultural identity, volunteering, sports & healthy living, family and neighbourhood.

As a social inclusion bridge builder for mental health, I work with clients who wish to access Arts & Culture . The social inclusion approach will ask a client to identify which social domains they would like to prioritise for inclusion in mainstream. The bridge builder's role is then to signpost the client to the mainstream domain which has been prioritised. In order to facilitate this, bridge builders must have a wide network of local and regional contacts in his or her field of expertise. Further support relates only to how much or how little the client requests.

As Arts bridge builder for example, I need to know what is out there for clients who may wish to do arts courses or rehearse and record their music. Other clients may be seeking self-employment through tutoring, performing or composing. All of these aspirational goals have had successful outcomes, some of them quite outstanding. All the clients referred to mainstream come from a background of 'severe and enduring' mental health conditions.

The bridge building service is not a clinical or diagnostic one, although we work closely with Community Mental Health Teams. It is designed to enable clients to participate in mainstream, based on their own preferences, choices, skills and dreams. Clients are free to choose whether to disclose their illnesses or not.

When the arts bridge builder meets with a client, the key questions are 'what do you wish to see happen for yourself' or 'what would you like to do'. Bridge building focuses on aspiration, goals and innate gifts and talents. And that's it.

How Social Inclusion is good for business

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.

Wednesday 7 July 2010

Is anti-stigma the new stigma?

Is anti-stigma the new stigma?

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

Time to Change advises that 'at Get Moving events it is ideal if there is a 50/50 mix of individuals with experience of mental health problems and those without in order to maximise the amount of stigma broken down and the number of stereotypes challenged.' Events suggested are football games, group walks or 'a dance routine which is then performed'.

The campaign promotes 'social contact' and 'social contact theory' put into practice' to challenge stigma and discrimination'.

Why should people with mental health conditions have to access mainstream activities as part of a campaign?

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 most 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 direct payments.

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?

Saturday 3 July 2010

'Taking Care of Business' - Mind campaign

Mind’s ‘Taking care of Business’ campaign highlights the initiatives being taken by many employers around issues of mental health at work.

Supported by business ‘dragon’ Duncan Bannatyne, the campaign shows that employers are becoming aware of the need to address and support good mental health in the workplace.

The Mind campaign underlines the message that the promotion of good mental health helps employers ‘increase productivity, improve staff performance and save thousands of pounds’.

Mind also hosts a series of follow-up programmes designed to actively encourage good mental health in the workplace.

Some of the companies who have signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. James Kenrick at Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.

Hewitt also initiated a staff health audit which identified stress, anxiety and depression as ‘real issues within the organisation’. James Kenrick states that:

‘after the health audit we sourced a stress vocational rehabilitation service, which has a vocational focus and is staffed by psychologists. Employees who have been absent for 10 days or more are referred for an initial assessment, and recommended the most appropriate treatment plan. We have found that this service, along with early intervention, has greatly reduced the days lost through stress-related absence and stopped stress-related disability altogether’.

Proactive management of mental health in the workplace has allowed Hewitt Associates to save ‘nearly £400’ per employee. More importantly, as Kenrick states:

‘it's the intangible elements that are most rewarding. The feedback from staff who have been helped to recover from difficult circumstances has been exceptional’.

EDF Energy is a major electricity provider. A workplace audit showed that the company was losing around £1.4m in productivity each year as a result of mental ill health among its employees. As part of an Employee Support Programme the company offered psychological support (cognitive behavioural therapy) to employees and trained over 1,000 managers to recognise psychological ill health among staff and to minimise its effects. This resulted in an improvement in productivity which saved the organisation approximately £228,000 per year. Job satisfaction also rose from 36 to 68% (Business in the Community, 2009).