Transcript Mental Health Trusts Service Improvement

Mental Health, Social Inclusion
& Co-production
David Morris
National Social Inclusion Programme
Co-production in mental health
- a fundamental value
- but needs radically realigned thinking:
•
•
•
•
•
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‘Community’ does exist and
policy co-constructs it.
People have multiple identities and
we need to engage with them all.
Independence may not trump interdependence..
Paid work - a very good thing, but not everything.
Policy context
Policy in MH defined by:
• Mental Health Strategy – ‘Modernising Mental Health
Services: Safe, Sound and Supportive’ (DH 1998)
• National service framework for MH (DH 1999)
• Choosing Health (DH 2004)
• Improving the life chances of disabled people
(DWP, DH, DfES, ODPM 2005)
• ‘Our health, Our Care, Our Say’ (DH 2006)
• Local Government and Public Involvement Bill
(DCLG 2007)
Policy context
…and for social inclusion in mental health by:
• Mental Health and Social Exclusion
(Social Exclusion Unit 2004)
• Reaching Out: An Action Plan on Social Exclusion
(Cabinet Office 2006)
Key policy dimensions
• Most disadvantaged groups: promoting independent
living; improving lives by giving service users more
choice and control - self-directed care; individual
budgets; Direct Payments
• Communities: promoting health and wellbeing in
context of the ‘public mental health’ (new
commissioning framework published 7.3.07)
• All: involving public, patients, service users and
carers in planning and delivery of care
Policy context
…and for social inclusion in mental health by:
• Mental Health and Social Exclusion
(Social Exclusion Unit 2004)
• Reaching Out: An Action Plan on Social Exclusion
(Cabinet Office 2006)
Published June 2004
Office of the Deputy Prime Minister
Challenging exclusion - the vision
behind the SEU report
“Social Inclusion for people with mental health problems is a
moral imperative”
(Minister for Health, launching SEU report June 04)
“Our vision is a future where people with mental health
problems have the same opportunities to work and
participate in their communities as any other citizen”
(SEU Report p94)
SEU Project – remit & timescales
• How to enable more adults with mental health
problems to enter and retain work?
• How to enable social participation and access to
services?
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Feb 2003 to Mar 2004: consultation; -
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June 2004: publication
•
Sept 2004: implementation starts
Less than a quarter of adults with mental health
problems are in work - the lowest employment rate
among disabled people
LFS data for England only
80
Main barriers
70
– fear of losing benefits
60
50
40
– employers’ attitudes
30
– fluctuating nature of condition
20
– low expectations of health
10
0
1998
1999 2000 2001 2002
whole population
physical health problems
mental health problems
2003
professionals
Social exclusion has multiple impacts
• What can happen when people or areas suffer from a
combination of linked problems – unemployment,
poor skills, low incomes, poor housing, high crime,
bad health and family breakdown.
• Characterised by the inter - relatedness of problems
that are mutually reinforcing; combined they create a
fast moving, complex and vicious cycle.
(Social Exclusion Unit 2004)
People are excluded in many different ways
• low levels of participation in
• FE/leisure activities
not eligible to be
juror or school governor
financial services
hard to access
physical illness
overlooked
harassment complaint
not taken seriously
1/4 tenants with serious
arrears at risk of eviction
People can become very isolated
Outer circle:
Services
places where
friendships
start.
Inner circle:
People who
matter
Sport/





Employment
Education
exercise
Family/
neighbourhood
Volunteering
Arts and Culture
Faith communities
Sue attends the day centre and the clinic
She has 5 friends she sees at outpatients or the day centre
National Social Inclusion Programme
• 3 year programme from Sept 04 – 07, based at National
Institute for Mental Health in England
• National and regional centres
• Cross - sectoral; cross - government
• National and regional activity in partnership
• Linked to public health, mental health promotion,
equalities programmes
NATIONAL SOCIAL INCLUSION PROGRAMME
SE
STIGMA/
DISCRIM’
ION
NATIONAL LEVEL
CENTRAL CROSS – GOVERNMENT TEAM
REGIONAL LEVEL
8 DEVELOPMENT CENTRES – Social Inclusion leads
SW
EMPLOYMENT
LON
INCOME/
BENEFITS
EM
EDUC’N
NE,Y&H
HOUSING
NW
WM
E
CTT’Y
SOCIAL
DIRECT
PARTIC’N
NETW’KS
PAYM’TS
Cross cutting work streams:
Workforce Development - Research & Evidence - Community Engagement - Criminal Justice - Inequalities
AFFILIATES NETWORK: 50 organisations - users, voluntary, professional
Community Participation
Day service modernisation
is key component
Refocusing Day Services:
– traditional day services provide specialist support
solely for those with mental health problems in a
segregated day facility
– traditional day services often fail to meet the
diverse needs of the community they serve
– being in work and having social contacts is
strongly associated with improved health and wellbeing
Day service modernisation three more policy documents
• ‘From segregation to Inclusion’:
– Commissioning guidance on day services for
people with mental health problems
• Supporting women into the mainstream:
– Commissioning women-only community day
services
• Direct Payments for people with mental health
problems - a guide to action
(all NSIP 2005)
Day service modernisation
Modernised approach achieves 4 goals:
•
•
•
•
Opportunities for social contact and support
Support to retain existing roles, contacts, activities.
Support to access new roles, relationships, activities.
Opportunities for service users to run their own
services and provide their own support
All better achieved with co-production and community
bridge building in mind!
NSIP influencing widely across sectors
& engaging communities
‘Together we can improve our health and well-being …
… What will be done:
Tackle the social exclusion experienced by people
with mental health problems by bringing together
local communities and citizens with mental health
needs in partnership with the relevant public services
‘Together We Can’ (2005) Strategy for Community Engagement,
Home Office, Civil Renewal Unit
Co-production means…
linking governance to social capital through
realistic approaches to community engagement:
‘Rather than expect everyone to participate equally in
formal governance, we should try to make more
people’s everyday civic engagement count by
designing the formal governance in a way that taps
into the informal spaces of community life that they
routinely inhabit.’
Community Participation, Who benefits? (2006) Skidmore, P. Bound, K.
Lownsbrough, H. Joseph Rowntree Foundation
The informal spaces of community life that
people routinely inhabit
The places with which people are already
familiar – the … newsagent or post office hold
the key to engaging them in governance
activity. These places and the organisations
that occupy them act as the everyday bridge
between ordinary people and more formal
governance activities.
Participation, Who benefits? (2006) Skidmore, P. Bound, K.
Lownsbrough, H. Joseph Rowntree Foundation
‘The places with which people are already
familiar ….
…also the setting for
co-produced
services?
Thank you
www.socialinclusion.org.uk
[email protected]