For many years mainstream has been perceived and practised as a key component of the care pathway in mental health provision.
At several stages of the pathway into mainstream there are roadblocks. These can occur from the individual client, from services, even from families and carers. An individual can feel apprehensive of stepping over the threshold into mainstream activities. This can be for a variety of reasons, ranging from self-stigma or from being so long in the mental health system that independence seems a very distant option. Contrary to some current opinion, it is not stigma from mainstream society that creates the main roadblock.
Dr. Pat Deegan's belief is that too often the health system can encourage what she calls 'a career in mental health' and nothing else. This viewpoint is based on her experience as a service user and it still holds true.
A great deal is being achieved by service users themselves to challenge the roadblocks. This is particularly true where creative and personalised use of direct payments and individual budgets have really taken off around the UK. It hasn't happened everywhere but some immensely inspiring stories and testimonials can be viewed at the NMHDU website.
Creative use of direct payments in mental health recovery is currently sporadic. The intention was that this should increase towards full implementation of the personalisation programme. Invididual budgets were scheduled to become the engine for much healthcare practice all over the UK by 2013. However, this is now completely overshadowed and possibly lost permanently, in the thrust towards GP consortia and budget management.
Alongside the sudden disappearance of direct payments is the disappearing access to therapies, both for primary and secondary care patients. Secondary care clients have often lost out in the therapies scenario for a variety of reasons. But clients in primary care are still entitled to a reasonably smooth road to psychological therapies. Entitlement does not ensure that those therapy services are available and in practice these too are disappearing along with personalisation and individual budgets.
Of course any client is free to fund their own mainstream recovery pathway and many do. The outcomes in this area alone (south-west London) have often been formidable. A composer who has funded her own recordings and launches now has self-employment through her music. Many are those who have accessed adult education courses and further training. Individuals have re-accessed faith venues which they had previously felt unable to enter for many years.
Not all these initiatives require direct payments - anyway those have now dried up. Many activities are free to access or funded by individual clients from their own pockets. Where direct payment has been needed it has often made the crucial difference.
Third-sector organisations also do great work in promoting access to mainstream through a variety of initiatives. 'Emergence' is an arts group run by and for service users who are also visual artists. In London and around the country 'Emergence' has pioneered access to visual arts as well as giving a platform for creativity and exhibition spaces for artists with personality disorder.
'Imagine' in south west London and Surrey also promotes a variety of arts opportunities including music production and visual arts. These are open to service users but take place in mainstream settings.
Mainstream environments have their own health, safety and insurance policies. As a consumer, the service user to entitled to the protection of these policies along with every other mainstream customer and client.
JVT
Friday 22 April 2011
Roadblocks in Mainstream
For many years mainstream has been perceived and practised as a key component of the care pathway in mental health provision.
At several stages of the pathway into mainstream there are roadblocks. These can occur from the individual client, from services, even from families and carers. An individual can feel apprehensive of stepping over the threshold into mainstream activities. This can be for a variety of reasons, ranging from self-stigma or from being so long in the mental health system that independence seems a very distant option. Contrary to some current opinion, it is not stigma from mainstream society that creates the main roadblock.
Dr. Pat Deegan's belief is that too often the health system can encourage what she calls 'a career in mental health' and nothing else. This viewpoint is based on her experience as a service user and it still holds true.
A great deal is being achieved by service users themselves to challenge the roadblocks. This is particularly true where creative and personalised use of direct payments and individual budgets have really taken off around the UK. It hasn't happened everywhere but some immensely inspiring stories and testimonials can be viewed at the NMHDU website.
Creative use of direct payments in mental health recovery is currently sporadic. The intention was that this should increase towards full implementation of the personalisation programme. Invididual budgets were scheduled to become the engine for much healthcare practice all over the UK by 2013. However, this is now completely overshadowed and possibly lost permanently, in the thrust towards GP consortia and budget management.
Alongside the sudden disappearance of direct payments is the disappearing access to therapies, both for primary and secondary care patients. Secondary care clients have often lost out in the therapies scenario for a variety of reasons. But clients in primary care are still entitled to a reasonably smooth road to psychological therapies. Entitlement does not ensure that those therapy services are available and in practice these too are disappearing along with personalisation and individual budgets.
Of course any client is free to fund their own mainstream recovery pathway and many do. The outcomes in this area alone (south-west London) have often been formidable. A composer who has funded her own recordings and launches now has self-employment through her music. Many are those who have accessed adult education courses and further training. Individuals have re-accessed faith venues which they had previously felt unable to enter for many years.
Not all these initiatives require direct payments - anyway those have now dried up. Many activities are free to access or funded by individual clients from their own pockets. Where direct payment has been needed it has often made the crucial difference.
Third-sector organisations also do great work in promoting access to mainstream through a variety of initiatives. 'Emergence' is an arts group run by and for service users who are also visual artists. In London and around the country 'Emergence' has pioneered access to visual arts as well as giving a platform for creativity and exhibition spaces for artists with personality disorder.
'Imagine' in south west London and Surrey also promotes a variety of arts opportunities including music production and visual arts. These are open to service users but take place in mainstream settings.
Mainstream environments have their own health, safety and insurance policies. As a consumer, the service user to entitled to the protection of these policies along with every other mainstream customer and client.
At several stages of the pathway into mainstream there are roadblocks. These can occur from the individual client, from services, even from families and carers. An individual can feel apprehensive of stepping over the threshold into mainstream activities. This can be for a variety of reasons, ranging from self-stigma or from being so long in the mental health system that independence seems a very distant option. Contrary to some current opinion, it is not stigma from mainstream society that creates the main roadblock.
Dr. Pat Deegan's belief is that too often the health system can encourage what she calls 'a career in mental health' and nothing else. This viewpoint is based on her experience as a service user and it still holds true.
A great deal is being achieved by service users themselves to challenge the roadblocks. This is particularly true where creative and personalised use of direct payments and individual budgets have really taken off around the UK. It hasn't happened everywhere but some immensely inspiring stories and testimonials can be viewed at the NMHDU website.
Creative use of direct payments in mental health recovery is currently sporadic. The intention was that this should increase towards full implementation of the personalisation programme. Invididual budgets were scheduled to become the engine for much healthcare practice all over the UK by 2013. However, this is now completely overshadowed and possibly lost permanently, in the thrust towards GP consortia and budget management.
Alongside the sudden disappearance of direct payments is the disappearing access to therapies, both for primary and secondary care patients. Secondary care clients have often lost out in the therapies scenario for a variety of reasons. But clients in primary care are still entitled to a reasonably smooth road to psychological therapies. Entitlement does not ensure that those therapy services are available and in practice these too are disappearing along with personalisation and individual budgets.
Of course any client is free to fund their own mainstream recovery pathway and many do. The outcomes in this area alone (south-west London) have often been formidable. A composer who has funded her own recordings and launches now has self-employment through her music. Many are those who have accessed adult education courses and further training. Individuals have re-accessed faith venues which they had previously felt unable to enter for many years.
Not all these initiatives require direct payments - anyway those have now dried up. Many activities are free to access or funded by individual clients from their own pockets. Where direct payment has been needed it has often made the crucial difference.
Third-sector organisations also do great work in promoting access to mainstream through a variety of initiatives. 'Emergence' is an arts group run by and for service users who are also visual artists. In London and around the country 'Emergence' has pioneered access to visual arts as well as giving a platform for creativity and exhibition spaces for artists with personality disorder.
'Imagine' in south west London and Surrey also promotes a variety of arts opportunities including music production and visual arts. These are open to service users but take place in mainstream settings.
Mainstream environments have their own health, safety and insurance policies. As a consumer, the service user to entitled to the protection of these policies along with every other mainstream customer and client.
Friday 4 March 2011
What does Dr. 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.
Friday 7 January 2011
Social Inclusion - so good for business
The business case for mental health awareness is evidenced by the increasing numbers of employers who are commissioning mental health awareness trainings for their workforce. Employers want trainings which enable their staff to understand more about common mental health conditions. Understanding mental health means that staff can work better with clients and customers. It also allows staff to feel less isolated about personal issues around health and well-being.
Mental health awareness provides the opportunity for employers and employees to find out more about the law as it relates to employment and mental health.
Enlightened employers will seek to develop a workforce team which is happy rather than unhappy, fulfilled rather than excluded. Courses such as MHFA (Mental Health First Aid) show that attendees often feel that one of the benefits of the training in that it allows for a safe space. A safe space where individuals can share feelings about their personal well-being in addition to learning about the broader aspects of mental health conditions and the appropriate interventions.
In addition to mental health, it makes solid sense for businesses to incorporate awareness of social inclusion and mainstream. Returning to or accessing mainstream living is now a key part of the care pathway for those diagnosed with 'severe and enduring' mental health diagnoses. It is equally important for people who may be experiencing conditions such as anxiety, phobia or stress at work.
Both groups - those in primary and secondary care - are being signposted to mainstream life rather than to special settings as a central plank of the recovery process. The implications for any service provider - and that includes businesses - are crucial. Businesses and services are at the receiving end of mainstream.
Clients in recovery are choosing to access their personal goals through a diverse range of outlets. These could range from faith venues to volunteer bureaus, from retail outlets to sports centres, from recording studios to adult education colleges, from libraries to personal counselors, from training venues to department stores.
For businesses, it's not just one in four of their staff who may be experiencing mental health challenges, it's also one in four of their clients, customers and service consumers. Mental health challenges will also have an impact on one in three families. Disclosed or undisclosed, it's clear that mental health and well-being lie at the heart of our transactions and interactions.
Mental health awareness provides the opportunity for employers and employees to find out more about the law as it relates to employment and mental health.
Enlightened employers will seek to develop a workforce team which is happy rather than unhappy, fulfilled rather than excluded. Courses such as MHFA (Mental Health First Aid) show that attendees often feel that one of the benefits of the training in that it allows for a safe space. A safe space where individuals can share feelings about their personal well-being in addition to learning about the broader aspects of mental health conditions and the appropriate interventions.
In addition to mental health, it makes solid sense for businesses to incorporate awareness of social inclusion and mainstream. Returning to or accessing mainstream living is now a key part of the care pathway for those diagnosed with 'severe and enduring' mental health diagnoses. It is equally important for people who may be experiencing conditions such as anxiety, phobia or stress at work.
Both groups - those in primary and secondary care - are being signposted to mainstream life rather than to special settings as a central plank of the recovery process. The implications for any service provider - and that includes businesses - are crucial. Businesses and services are at the receiving end of mainstream.
Clients in recovery are choosing to access their personal goals through a diverse range of outlets. These could range from faith venues to volunteer bureaus, from retail outlets to sports centres, from recording studios to adult education colleges, from libraries to personal counselors, from training venues to department stores.
For businesses, it's not just one in four of their staff who may be experiencing mental health challenges, it's also one in four of their clients, customers and service consumers. Mental health challenges will also have an impact on one in three families. Disclosed or undisclosed, it's clear that mental health and well-being lie at the heart of our transactions and interactions.
Wednesday 29 December 2010
Review of the Year 2010 - part II
Questions
What was the mental health scene like in 2010 for those at the grittier end of the stick? What was 2010 like for people in secondary care? For people under community mental health teams?
Was there more recovery in 2010? Were people in secondary care able to access mainstream more in 2010? Were they less doomed to what Dr. Pat Deegan calls 'a career in mental health'?
Did people with severe and enduring mental health conditions receive enough support from services? Did they receive the right support? Did the support help them or hinder them?
Some answers
Throughout 2010, statutory and voluntary services responded to the health challenge of independence and mainstream in several key ways. Firstly, mental health teams set up some important initiatives. These were geared towards client independence and recovery. Many predominantly service-user led.
Recovery University in the south-west London borough of Merton enables secondary care clients to access a wide spectrum of trainings and skillsets. These include preparing for work, independence and life skills, confidence building, anger management and many more. Recovery University also trains service users as trainers for forthcoming courses.
Other community initiatives are also up and running, including wellbeing programmes and access to psychological therapies. However, pyschological therapies in non-clinical settings are still not available should you happen to have a severe and enduring mental health condition.
Training the trainers often draws upon experiences and qualifications which service users have already gained within their life journeys. Mainstream groups have also utilised service user skills as part of their own training programmes in areas such as visual arts, music and creative writing. This has taken the recovery university one stage further, providing paid employment and access to mainstream.
Statutory services continued to have success in keeping people out of hospital or limiting hospital stays to a minimum. The downside of this is that more and more people are being discharged from statutory services altogether. In 2011 this will inevitably result in more pressure on GP services, as it is these practitioners who will become responsible under the latest government directives.
The rolling-out of the personalisation programme should mean more access to direct payments for many clients under mental health care plans. It should also mean more and more creative uses of direct payments, as DP is being promoted for any activity or outcome that a client deems relevant to his or her recovery. The Personal Stories videos on the NMHDU site bears witness to some of these outcomes. With more and more people being discharged from mental health services, it is crucial that personalisation is a success in the new year.
What was the mental health scene like in 2010 for those at the grittier end of the stick? What was 2010 like for people in secondary care? For people under community mental health teams?
Was there more recovery in 2010? Were people in secondary care able to access mainstream more in 2010? Were they less doomed to what Dr. Pat Deegan calls 'a career in mental health'?
Did people with severe and enduring mental health conditions receive enough support from services? Did they receive the right support? Did the support help them or hinder them?
Some answers
Throughout 2010, statutory and voluntary services responded to the health challenge of independence and mainstream in several key ways. Firstly, mental health teams set up some important initiatives. These were geared towards client independence and recovery. Many predominantly service-user led.
Recovery University in the south-west London borough of Merton enables secondary care clients to access a wide spectrum of trainings and skillsets. These include preparing for work, independence and life skills, confidence building, anger management and many more. Recovery University also trains service users as trainers for forthcoming courses.
Other community initiatives are also up and running, including wellbeing programmes and access to psychological therapies. However, pyschological therapies in non-clinical settings are still not available should you happen to have a severe and enduring mental health condition.
Training the trainers often draws upon experiences and qualifications which service users have already gained within their life journeys. Mainstream groups have also utilised service user skills as part of their own training programmes in areas such as visual arts, music and creative writing. This has taken the recovery university one stage further, providing paid employment and access to mainstream.
Statutory services continued to have success in keeping people out of hospital or limiting hospital stays to a minimum. The downside of this is that more and more people are being discharged from statutory services altogether. In 2011 this will inevitably result in more pressure on GP services, as it is these practitioners who will become responsible under the latest government directives.
The rolling-out of the personalisation programme should mean more access to direct payments for many clients under mental health care plans. It should also mean more and more creative uses of direct payments, as DP is being promoted for any activity or outcome that a client deems relevant to his or her recovery. The Personal Stories videos on the NMHDU site bears witness to some of these outcomes. With more and more people being discharged from mental health services, it is crucial that personalisation is a success in the new year.
Review of the Year 2010 - part I
The background
Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a round-up and reinforcement of the initiatives embodied in the Disability Discrimination Act (DDA), designed to address key concerns around health and legal rights in the workplace.
Major businesses and business organisations have also addressed the massive loss to the economy and to human happiness that can be caused by mental ill-health. In 2005 the Confederation of British Industry was concerned enough to commission its own research. Business owners and directors have not been slow in following the confederation's lead.
The year 2010
Supported by business ‘dragon’ Duncan Bannatyne, Mind’s ‘Taking care of Business’ campaign continues to highlight the initiatives being taken by many employers around issues of mental health at work. Some of the companies who signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.
Anti-stigma group Shift is also 'high visibility' in its tireless campaigning for an end to mental health discrimination and in its promotion of understanding the need to support good mental health in the workplace.
Equality Act
The increasing awareness of how mental health affects us all culminated in 2010 with the Equality Act.
The Act reinforces all the implementations of the Disability Discrimination Act (DDA) and in particular, the rights of employees who have disclosed a mental health condition. Before the act came into force, employees had the legal right to reasonable adjustments in their working conditions where appropriate. With the Equality Act, the burden of proof now lies with the employer to show that adjustments have been made rather than with the employee to prove they haven't. It is a highly significant rights-based change.
Carol Black's 2008 report 'Working for a Healthier Tomorrow' was a round-up and reinforcement of the initiatives embodied in the Disability Discrimination Act (DDA), designed to address key concerns around health and legal rights in the workplace.
Major businesses and business organisations have also addressed the massive loss to the economy and to human happiness that can be caused by mental ill-health. In 2005 the Confederation of British Industry was concerned enough to commission its own research. Business owners and directors have not been slow in following the confederation's lead.
The year 2010
Supported by business ‘dragon’ Duncan Bannatyne, Mind’s ‘Taking care of Business’ campaign continues to highlight the initiatives being taken by many employers around issues of mental health at work. Some of the companies who signed up to support the Mind campaign include EDF energy, BT, Hewitt Consultancy, AXA and police and security services. Hewitt Associates helped set up an Employee Assistance programme allowing staff access to counselling services where appropriate.
Anti-stigma group Shift is also 'high visibility' in its tireless campaigning for an end to mental health discrimination and in its promotion of understanding the need to support good mental health in the workplace.
Equality Act
The increasing awareness of how mental health affects us all culminated in 2010 with the Equality Act.
The Act reinforces all the implementations of the Disability Discrimination Act (DDA) and in particular, the rights of employees who have disclosed a mental health condition. Before the act came into force, employees had the legal right to reasonable adjustments in their working conditions where appropriate. With the Equality Act, the burden of proof now lies with the employer to show that adjustments have been made rather than with the employee to prove they haven't. It is a highly significant rights-based change.
Thursday 11 November 2010
Equality Act 2010
During the parliamentary stages of the Equality Bill, mental health organisation Mind lobbied with other mental health and disability charities to get a ban on pre-employment questionnaires included in the Act. After securing cross-party support for the principle of a ban on questions that ask about a candidate's medical history and putting considerable pressure on Ministers, the last Government introduced a new clause to the Equality Bill making these questions unlawful.
The Equality Act came into force on October 1st 2010. The act bans companies from finding out whether potential employees are healthy enough to work for them prior to an offer of employment. Candidates will no longer be expected to declare medical issues during the recruitment stage unless it is specifically related to their job role.
Equality campaigners have long argued that employers discriminate against prospective employees with mental health issues, disabilities or a long history of illness, putting people off applying for a job.
However, 65pc of employers still ask a candidate about their health prior to a job offer, and 48pc ask potential employees to fill out a questionnaire detailing medical conditions and sickness records, according to a poll of 100 companies by law firm Pannone.
Jim Lister, head of employment law at Pannone, said: "The penalties for employers include investigation by the Equality and Human Rights Commission and the reversal of the burden of proof, meaning that the employer will be assumed to have discriminated, unless it can show there was another reason for non-selection.
Organisations that learn of a person's health issue after the job offer but fail to make reasonable adjustments and are forced to withdraw the offer face litigation, lawyers have said.
The reversal of the burden of proof is highly significant. Effectively this means that an employee who feels discriminated against on the grounds of mental ill-health, for example, is not required to prove that this is the case. It becomes the employer's responsibility to prove that this is not the case. If proved otherwise, the employer will be required by law to comply with equalities legislation and where necessary, to make reasonable adjustments on behalf of the employee.
The Equality Act came into force on October 1st 2010. The act bans companies from finding out whether potential employees are healthy enough to work for them prior to an offer of employment. Candidates will no longer be expected to declare medical issues during the recruitment stage unless it is specifically related to their job role.
Equality campaigners have long argued that employers discriminate against prospective employees with mental health issues, disabilities or a long history of illness, putting people off applying for a job.
However, 65pc of employers still ask a candidate about their health prior to a job offer, and 48pc ask potential employees to fill out a questionnaire detailing medical conditions and sickness records, according to a poll of 100 companies by law firm Pannone.
Jim Lister, head of employment law at Pannone, said: "The penalties for employers include investigation by the Equality and Human Rights Commission and the reversal of the burden of proof, meaning that the employer will be assumed to have discriminated, unless it can show there was another reason for non-selection.
Organisations that learn of a person's health issue after the job offer but fail to make reasonable adjustments and are forced to withdraw the offer face litigation, lawyers have said.
The reversal of the burden of proof is highly significant. Effectively this means that an employee who feels discriminated against on the grounds of mental ill-health, for example, is not required to prove that this is the case. It becomes the employer's responsibility to prove that this is not the case. If proved otherwise, the employer will be required by law to comply with equalities legislation and where necessary, to make reasonable adjustments on behalf of the employee.
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