Transcript New day services

Changing practice and service
development
– implementing the SEU report,
implications and expectations for
modernised day services
David Morris
Programme Director,
National Social Inclusion Programme
National Institute for Mental Health in England
Social Exclusion Unit
Mental Health Project - remit and time scale
• How to enable more adults with mental health problems to
enter and retain work?
• How to enable social participation and access to services?
• Feb 03 to Mar 04: consultation - users, organisations and
Ministers
• Publication: June 04; implementation: from Sept 04
Social exclusion defined
• 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)
www.socialexclusionunit.gov.uk
Tel: 0870 1226 236
Inclusion - the Ministerial vision
“Social Inclusion for people with mental health
problems is a ‘moral imperative”
(Rosie Winterton 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)
Less than 40% of employers would
recruit people with mental health problems
% of employers who would recruit from
different groups
ONE evaluation (DWP 2001)
88
100
78
62
37
50
0
lone parents
long-term unemployed
physical health problems
mental health problems
Two thirds put off
applying for jobs for
butfear
many
...
of unfair
 highly skilled
treatment
 relevant experience
 able to work with
minimal adjustment
Less than a quarter of adults with mental
health problems are in work
LFS data for England only
Main barriers
80
• fear of losing benefits
70
60
• employers’ attitudes
50
• fluctuating nature of
40
30
condition
20
• low expectations of health
10
professionals
0
1998
1999 2000 2001 2002
whole population
physical health problems
mental health problems
2003
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
serious illness
overlooked
harassment complaint
not taken seriously
1/4 tenants with serious
arrears/at risk of eviction
People can become very isolated
Services

Sport/
exercise




Family/
neighbourhood
Employment
Education
Volunteering
Faith
communities
Arts and
Culture
Sue attends the day centre and the clinic.
She has 5 friends she sees at outpatients or the day centre
Action plan - six main themes
stigma and discrimination
– sustained programme to challenge discrimination: 5-year plan launched
by Rosie Winterton on 23 June
– practical teaching resources for schools and monitoring of broadcast
media with Ofcom
– promoting best practice in the public sector
role of health and social care services
– implementing evidence-based practice on employment, working towards
an employment adviser for everyone with severe mental health problems
– improved access in primary care to advice on employment and
community activities
– changing day services so they help people to do things in their
community
– strengthened training on social inclusion
Action plan - six main themes (2)
employment
– improved training on mental health issues for Jobcentre Plus staff
– £1.5m from the Phoenix Fund to support people interested in self
employment / enterprise
– clarifying benefit rules for people wanting to return to work
– improved support for employers and job retention
supporting families and community participation
– targeted family support for parents with mental health problems and
their children
– improved support to access education and training opportunities
– removal of unnecessary barriers to community roles such as jury
service
Action Plan - six main themes (3)
getting the basics right
- new guidance to housing authorities to prevent unnecessary
evictions
- improved access to financial and legal advice and affordable
transport
making it happen
• implementation programme with ministerial oversight:
- cross-govt team
- independent advisory group to advise govt. on progress
- local implementation led by PCTs and Local Authorities
- effective use of voluntary and community sector
Why is this report so important?
• establishes action on inclusive practice as a moral
imperative, underpinning citizen rights
• calls for balanced action on the multiple impact of
exclusion – on employment and wider aspects of
participation
• supports action on inequalities by making inequity of
access and participation an equalities issue
• demands attention as much to the mainstream; the
ordinary as the specialist – centralises the role of primary
care as setting for vocational advice
• signals need for cultural shift both in and beyond the
service system
• Recognises that inclusion is effect and cause in stigma
and discrimination
National Social Inclusion Programme
Capacity – 3 key sources:
• Central cross govt. multi-agency team
• Regional SI resources – SI leads and local projects/people
• Affiliates network – 40 User/NGO/Professional orgs
Content:
• 8 major projects, each led by DC with central support
• 5 cross cutting work streams, led by central team
Governance:
• Cross govt network – key officials
• Independent Advisory Group – reports to Ministers
• SEU – monitoring team
Programme Delivery - leadership integration, accountability for corporate programme goals
NATIONAL CROSS - GOVERNMENT IMPLEMENTATION TEAM
Project Support Leading cross-cutting action
Programme Delivery - locality of corporate programme goals
DEVELOPMENT CENTRES - Project Leadership
DC 1
SW
DC2
DC3
DC4
DC5
DC 6
DC7
DC8
SE
LON
EM
NE,Y&H
NW
WM
E
Project 1
Project 2
Project 3
Project 4
Project 5
Stigma &
Discrimination
(Delivery by
S&D prog)
Project 6
Project 7
Project 8
Employment
Income &
Benefits
Education
Housing
Community
Participation
Social
Networks
Direct
Payments
cross cutting action themes
Workforce Development
Research Evidence
Community Engagement
Criminal Justice
Affiliated Organisations - NGOs x 20 - 25
Project Teams:
Management & Delivery
Support & Stakeholder
• Service User organisation rep
• Good practice networks
•Development Centre SI Lead
•Affiliate organisation(s)
•National Implementation team rep
•Affiliate organisation(s)
Tackling Inequalities
Early progress
Includes:
• Commissioning guidance in preparation:
- day services modernisation
- employment
• Direct payments guidance completed
• DfES advice to Learning and Skills Council on MH issued
• Project teams and plans x 8 in place;
• National ‘New Ways of Working’ guidance to support S.I.
agreed
Inclusion, barriers and challenges
• growing the evidence base realistically to support
measurement and monitoring of progress
• making the link between MHP and MH Services stick moving on from ‘silos’ to cross - boundary, work in the
‘ordinary world’
• challenging cynicism; inclusion being seen as the
‘softener’ for MH Bill
• capacity for organisational change at local level
• sustaining cross - government action nationally
Barriers and challenges 2
• embedding creative practice in organisations not just
individuals
• developing primary care and re - equipping social care –
making it a commissioning priority
• exploiting opportunities for community level action and
engagement afforded by local regeneration and Local
Strategic Partnerships
• making inclusive practice and culture a mainstream aspect
of service organisation; at heart of leadership and
workforce development agendas for all professional and
non - aligned groups
• day services transformation - a major challenge
The day services agenda – post SEU
to:
‘transform day services into community
resources that promote social inclusion
through improved access to mainstream
opportunities’
Key objectives for day services
To provide for:
• access to community opportunities
• person – centred provision irrespective of severity
• clear links to community services and partner agencies
• befriending, advocacy and support to enable local service
access
• service user involvement in service design and delivery
• achieving social inclusion and employment outcomes
Dimensions of a modernised day service
• supports recovery
• portal to mainstream activity
• not principally a bricks and mortar enterprise
• specific to needs and aspirations of individual, but:
• builds the community capacity necessary to their
achievement through:
• alliances and partnerships beyond the MH system
community engagement for community bridge building
New day services – opportunities
• new focus on policy – neglected area
• resource potential, sometimes from mixed funding sources
• staff skills base – extensive experience of severe need
and rehabilitation objectives
• familiarity with carer and some social networks
• may have rich community links and effective inter-agency
relationships
New day services - risks
• loss of staff skills
• insensitive pace of change
• poor engagement with developing ‘replacement services’
• inadequate attention to specific personal need and/or
preference
• neglecting importance of internal social networks
• loss of public confidence in service
Inclusive practice means working
inclusively together
Thank you
[email protected]