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.
Wednesday, 30 March 2011
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'.
Tuesday, 21 December 2010
Review of the Year 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 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.
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 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
UK Mental Health Review of the Year 2010 - part 1
The background
Most years are momentous for mental health and 2010 has been no exception.
Momentous for individuals experiencing mental health conditions or their onset. Momentous for their family, friends and carers. Momentous for the way that society, the legislature and the populace have chosen to respond to the challenge of mental health.
There has been a clear road, a visible highway. The 2005 amendments to the Disability Discrimination Act (DDA) have been taken further with the Equality Act that came into force on October 1st 2010. Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a round-up and reinforcement of the initiatives embodied in DDA, designed to address key concerns of health and legal rights in the workplace.
The year 2010
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 to follow their confederation's lead.
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 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.
Most years are momentous for mental health and 2010 has been no exception.
Momentous for individuals experiencing mental health conditions or their onset. Momentous for their family, friends and carers. Momentous for the way that society, the legislature and the populace have chosen to respond to the challenge of mental health.
There has been a clear road, a visible highway. The 2005 amendments to the Disability Discrimination Act (DDA) have been taken further with the Equality Act that came into force on October 1st 2010. Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a round-up and reinforcement of the initiatives embodied in DDA, designed to address key concerns of health and legal rights in the workplace.
The year 2010
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 to follow their confederation's lead.
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 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
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