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. This has not happened because I have requested the venue to provide employment for my clients. Far from it, the venue itself has instigated the process that 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
Wednesday 13 July 2011
Friday 10 June 2011
The bridge builder's role
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'.
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'.
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.
Library 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.
Library 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 18 March 2011
Clinical and social models of care in mental health
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 professional care. This can 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. 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 professional care. This can 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. 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.
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 clinically 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.
All of these initiatives and more are continuing 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 and that changes are going to be 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 I feel 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, 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.
All of these initiatives and more are continuing 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 and that changes are going to be 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 I feel 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, it won't last.
Saturday 5 February 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'.
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'.
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