Earlier this week someone on Twitter drew my attention to this story from Benefits and Work blog about mental health charity Mind being part of Disability Works UK, a consortium bidding for a role delivering back to work and other services as part of the government’s Work Programme.
This means that Mind and other charities will be bidding to provide services contracted as part of Government plans to get more people off benefits and back into jobs.
Responses to this news tend to fall broadly into two camps. One camp feels in principle that charities should remain completely independent of funding from sources that may compromise their ability to represent their beneficiaries. You might call this the ‘how dare they betray us by getting into bed with our enemies’ camp. The other camp feels that charities, like any other organisation, need to make sure that they can bring in enough money to keep going and doing good things. This could be called the ‘business is business’ camp.
In a broad sense I can see both sides of the debate about large charities taking on sizable government contracts in areas around which they are currently campaigning.
For charities like Mind there is an awareness that it might be inappropriate to campaign about a particular policy with one hand while assisting its implementation with the other. This they more or less state in their response to Benefits and Work. In terms of their position, as far as many mental health activists are concerned, business isn’t just business.
Those who see that such organisations should refuse all such offers on principle can, however, be blind to the realities of the situation.
The logic used by large charities in going for these contracts is that they are the best placed to deliver a service that meets the needs of people with mental health difficulties. They would argue that, in effect, their delivery of the contract would take the edge off potential harshness of the regime by using their knowledge of what people with mental health difficulties need and want to make it work better. Whether you believe a particular charity’s claims to have superior knowledge, involvement or peer support available is not the same as being able to claim that these beliefs are a cynical ploy to justify wanton money grabbing.
The situation is that the services being contracted for will be delivered by someone. Charities such as Mind reason that it is better for them to provide these services, as organisations with some involvement of people with mental health difficulties, than other corporate providers that have no special understanding of people with mental health difficulties.
But there’s more to it.
A conflict of interest?
For many, it feels instinctively wrong that a charity like Mind should be involved in trying to get money from government contracts to help deliver elements of the benefits system. Why is this?
For some, it’s the idea that this represents a hypocrisy or a conflict of interest – How could a charity like Mind continue to campaign against a benefits system that they are somehow complicit in delivering?
For others it’s the idea that a body in theory representing the views and aspirations of people with mental health difficulties should, acting on their behalf, be involved in delivering something so detested by many who experience mental health difficulties themselves.
Both of these arguments are based upon the idea that Mind is a representative organisation and that its main aim is to take the views of people with mental health difficulties to power. This may be one of its aims but it isn’t quite where Mind is at now. Mind isn’t the equivalent of a mental health trade union with thousands and thousands of signed up people with mental health difficulties across the country feeding their views into the organisation democratically. Mind is a central body that campaigns, fundraises and researches and a federation of local Mind associations (LMAs) who vary greatly from place to place and from each other.
Mind nationally is still an organisation that for the most part does things on behalf of people with mental health difficulties. The public gives it money to help people with mental health difficulties. Over time Mind has quite rightly included more and more people with mental health difficulties in running their organisations, working for them, volunteering for them and steering them, but it is still recognisably a organisation for, not of, people with mental health difficulties. (Look out for future posts on this topic)
There is another argument, mostly coming from within the voluntary sector, that in moving into tendering for large contracts available to provide specific services, large charities are behaving like the large contract corporations to which they feel superior, edging out smaller community level charities and social enterprises. In this vision, large charities move in when services go out to tender like a plague of locusts, leaving only withered stalks to nourish the local voluntary sector.
The real issue, and one that I think will reoccur increasingly as the current spending squeeze continues, is not one of actual conflict of interest but perception of it.
Organisations need cash to stay alive. Many organisations survived on various forms of funding which are beginning to be cut or removed all together. Public services are moving increasingly in the direction of outsourcing their functions, leaving less and less money to be allotted at arms length and more tied to contracts.
Many organisations will find themselves having to play the only game in town to get in money, and the only game in town will often be providing services that their beneficiaries and supporters feel compromises their ability to trust in that organisation overall.
No matter how honourable the motives of Mind’s involvement in the Work Programme, there will always be some who see this as a taint on all their work, asking how they will be able to advise and support people on getting access to benefits while at the same time delivering some of the services they are advising about. Even if the parts of the overall Mind organisation doing this work are separate and firewalled from each other, as I’m sure they will be, it will be perception as much as reality that people go on.
This isn’t a problem that will dent Mind too much outside of mental health circles, as they are big enough with a wide enough donar-base to ride out any choppy waters, but for small charities and organisations this conflict is of pressing day to day importance.
The question is: How do mental health charities in these increasingly turbulent times maintain the trust and goodwill of those which they exist to serve?
And, as importantly, can individuals with an interest in mental health influence how charities behave on their behalf? And if they can, should they?
Mark Brown is editor of One in Four magazine
In 1997 I visited Australia on a mental health study trip funded by the Financial Times. I remember one meeting with the chief executive of ACROD, the Australian disability chief body now known as National Disabiltiy Services (http://www.nds.org.au/). The chief executive was refreshingly candid. “We’re like the gas baord,” she said. No nonsense about being anything more than a service provider.
This country is different. Charities like MIND aim to bridge the gap between service provision and representation. Yes, to my mind there is a conflict of interest but MIND and other charities are so very much part of the fabric of British life this is a conflict I live with just as I live with the Royal family. Nonetheless I do bear it in mind when judging MIND’s actions.
I tend to work on the principle of positive reinforcement. When MIND does something I like as it has done on service user victims of crime I let MIND know I approve. Quite what they read into my approval I do not know. I am a small operator. But yes there are times when I think that MIND gets it wrong. I tend to speak privately in the hope that quiet diplomacy is more persuasive than public shaming. Negotiating with national MIND is a bit like negotiating with an oil tanker. Local MIND organisations tend to be independent-minded but not necessarily responsive to user demands.
I do not have the personal power to alter the contract culture. If I did I would get the charities to strike harder bargains with government. I would not expect them to withdraw. But I would expect charities to develop stronger ties of accountability with the people they purpout to serve. I would not want MIND to see itself as a gas-board-style service provider in the Australian fashion.
I wish this issue had been properly researched and One in Four editor Mark Brown had resisted the urge to run with the dismissive ‘ Conflict is so 2008 ‘ pic as in the UK charities have faced the charge of thriving off the very social problems they were set up to deal with since Victorian times – often for very good reason – so its nothing new and today it isn’t only disabled mental health service users on benefits who believe the main UK mental health charity service providers have deeply conflicting ‘ provider ‘ and ‘ rights representational ‘ roles as Rowntree have produced a report detailing how this unacknowledged conflict of interest prevents service users genuinely participating in the planning , commissioning and delivery of local services .
Mark conveniently avoids this area of unacknowledged conflicted interest and seems more concerned to misrepresent Mind’s critics as luddites or worse. He also neglects to declare One in Four’s funded charitable status and his ideological proximity to Mind and the other mental health charity providers in almost everything save their ruthless damming and plundering of funding streams that edge out small ‘Mom and Pop’ charities like his. It’s a corporate ruthlessness Mark’s quite happy for Mind and other charities to flex around service users though, as if what Mind must do to survive could never conflict with the interests of the people it claims to represent.
The fact that disabled claimants are currently being brushed aside to suit the needs of large corporate charity providers like Mind is just the tip of the iceberg and its a shame the author cast the problem in a way that further stigmatised this user group as the Rowntree report also highlighted the problem of providers pushing their own agenda through use of kept ‘ service user representatives’ who are not representative at all
Beatrice Bray’s response mentioned the setup at ACROD , a straightforward no-nonsense Australian mental health charity service provider but in the UK context, growing concern about an array of conflicting interests thrown up by the ruthless contracts culture has led some like Hutton to argue that it is in the public interest for large provider charities heavily dependent on state funding to lose their charitable status and be treated like the provider businesses they actually are . Mind fits into this category and most members of the public who donate to Mind’s street chuggers would probably be very concerned to learn that Mind CEO Paul Farmer takes home a salary of around £100,000 a year, around £40,000 less than the Prime Minister.
Doesn’t exactly fit well with the secular Buddhist mindset the sector currently fakes or the ‘ Spirit Level ‘ thesis of how massive income gaps diminish happiness and wellbeing does it?
As for disabled mental health service users on benefits being out of touch with where Mind is currently at, as well as this being pretty contemptuous of this group it certainly isn’t the representational pitch Mind makes to the giving public and if Mind isn’t really in the business of ‘representing’ service users any more then the tens of millions of pounds the organisation has received from Government and the National Lottery for anti stigma and other rights representation projects need to be returned to the Treasury pronto.
This additional Government money has never been properly audited for effectiveness and it’s clearly increased the mental health charities representational profile and clout so Mark really needs to get his facts right as he implies that role has diminished. To many people , including some leading lights from the orginal user led Recovery movement, this funding also compromised the mental health charities willingness or ability to operate independently from Government so while we’ve seen a lot of massively funded and duplicated public facing anti stigma campaigns in the media in recent years we’ve seen little appetite from the likes of Mind to challenge prejudice and disability discrimination from the mental health system itself , for example, the lack of patient choice, the disintegration of services, the systemic bullying that still goes on because of this historical lack of basic rights and the resulting near arelational culture on the wards.
One in Four itself dismissed these issues as not ‘ aspirational enough to cover ‘ and ‘political ‘.
The biggest flaw in Mark’s defence of Mind though is that the UK’s largest provider charity has an absolutely abysmal record on providing quality training and employment as does the mental health sector generally as mental health organisations and their partners have simply juggled people around on useless training and job schemes or placed them in user involvement jobs within services that offered no real prospects or job security and were the first to be cut. The reality is Mind has no expertise in mainstream service user employment and the centre for Mental Health’s boasts of getting millions of people off benefits and into work were drowned out by the recession and the collapse of the Pathways to Work scheme with Mind’s partners claiming they couldn’t even cover their costs.
No wonder disabled claimants fear Mind colluding with Government mass targeting schemes.
Local Mind organisations are also bleeding jobs and instead of pushing for real services to help local groups support people at the stages of recovery and need they are at Mind CEO Paul Farmer is desperately negotiating with Government behind peoples backs to get money pumped back into the centre and he’s prepared to do whatever it takes to achieve this and service users know and fear that whereas Mark tries to pass it off as virtuous .
The truth is Mark is still fairly young, he has £70,000 in funding to fall back on and his friends in the charities to look out for him as long as he remains useful to them and he increasingly places his faith in the big society concept , but he’s a single man with no commitments, he’s recovered, he’s mobile, he’s still clubbing it, apparently free of disability and has no baggage and from that perspective it must be very easy for him to over identify with the seductive authoritarian Mind groupthink and to get frustrated with service users who wont conform to the view of mental health recovery he projects at them from his own experience. Mark needs to grow up and work with the people who are desperately asking for help and support to move on but not getting it if he thrives on dynamism rather than lazily subscribe to the Government’s reckless and bullying mass employment fantasies that are more likely to harm than help people.