There is a big gap between the aspirations of the governments strategy for mental health No Health without Mental Health and the reality of its implementation in inpatient settings, according to the The Care Quality Commission (CQC) in their Monitoring the Mental Health Act in 2011/12 report published in January.

The third such annual report, it represents the duty the CQC has to monitor how services in England exercise their powers and discharge their duties in relation to people who are detained in hospital under the Mental Health Act, or subject to community treatment orders (CTOs) or guardianship. While it found that there were excellent example of care, naming particular services and hospitals as examples it also found that there had not been enough forward progress from its previous two reports: “For example, 37% of care plans checked by CQC showed no evidence of patients’ views; there was no evidence that patients had been informed of their legal right to an Independent Mental Health Advocate (IMHA) in 21% of records reviewed; almost half (45%) of patient records reviewed still showed no evidence of consent to treatment discussions before the first administration of medication to a detained patient.”

Commenting in the summary the authors of the report state: “It is with great regret that CQC notes that there are themes that recur year on year and paint a picture of practice in some areas of mental health provision that is a far cry from the policy vision.”

Monitoring the Mental Health Act in 2011/12 can be downloaded from the CQC website: http://bit.ly/169oSrh

This news story appears in the Spring edition of ONEinFOUR magazine. Subcriptions cost just £10.00GBP for 4 quarterly issues.

Former Care Services Minister Paul Burstow, speaking at Public Service Events’ Mental Health: from Strategy to Reality conference on March 14th revealed worries about the level of funding being used for mental health in ENgland. While praising progress made by the Coalition government, he told delegates: “2 in 5 mental health trusts in England admit have staffing levels below Department of Health benchmarks.” Writing for The Telegraph newspaper on the same day he claimed: “The NHS default remains stubbornly biased towards physical health. A terrible false economy at the expense of people’s lives. Depressingly, in 2011/12 spending fell by 1%. Crisis resolution and assertive outreach both saw reduction, and while half the country protected spending, the other half made deep cuts… Dig deeper and you find huge variation from one part of the country to another. Previously unpublished data from the 2011/12 investment survey reveals that spending ranges from £315 per head to just £97.91 per head. The average spend is £166. These are figures reveal yet another postcode lottery.”

Burstow was announcing his appointment as of chair an independent commission by the think tank, Centre Forum. The commission will report next year.

Paul Jenkins of Rethink Mental Illness issued a statement in support of Burstow saying: “These figures highlight how patchy mental health care is across the country. Just 10 per cent of people with severe mental illness are currently being offered talking therapies for example. We have supporters who have sat on NHS waiting lists years for this basic treatment, which should be available to everyone who needs it.”

According to a Care Quality Commission update published on 12th March, in the first nine months of 2012/13, the CQC found that mental health and learning disability services struggled to maintain adequate staffing levels: in 104 inspections 80% services met the standard. This compared with 91% of inspections in the whole of 2011/12.

This news story appears in the Spring edition of ONEinFOUR magazine. Subcriptions cast just £10.00GBP for 4 quarterly issues.

One in Four editor Mark Brown summarises the NHS changes coming up on April 1st that may have passed you by

April the 1st is the date of one of the largest reorganisations of the National Health Service in England since its birth in 1948. Most of the changes are concerned with who makes decisions about health and social care and who services are provided by. These changes will not have a huge immediate impact on day-to-day services but are significant long-term changes to how the NHS works

Clinical Commissioning Groups (CCGs) formally replace Primary Care Trusts (PCTs) as the bodies which commission care. They have the power to buy services from any provider that meets agree standards, not just from within the NHS. Clinical Commissioning Groups include GP practices and other health professionals. While all GP practices have to be members of a CCG, the level of power individual GPs have will differs from area to area. While CCGs may have been initially envisaged as smaller and more local than PCTs, the 211 CCGs cover areas of similar size and population to the now defunct PCTs.

Local Authorities (councils) now have responsibility for public health, meaning they will control budgets for taking actions to improve the health of the whole community they serve . The government expects them to work more closely with other health and care providers, community groups and agencies, using knowledge of local communities to tackle challenges such as smoking,alcohol and drug misuse and obesity.

Sitting between CCGs and Local Authorities are Health and Wellbeing Boards, made up of health and social care decision makers and elected members of the public. A kind of steering group, Health and Wellbeing Boards feed into decision-making such as the Joint Strategic Needs Assessment process that works out what an area must to do to address the needs of those who live there. They are also expected to lead on reducing health inequalities (differences in health between different groups or areas). The Health and Wellbeing Board will, in theory, be where the views of members of the public will influence decisions.

Also on April 1st the process of switching patient and public engagement organisations from Local Involvement Networks (LINks) to Local Health Watch will be completed. LINks, first created by the Labour government in 2008, were independent bodies hosted by voluntary organisation intended to hold health and social care service to account and to feed in local views to decision makers. Each local HealthWatch has a similar remit. In some areas the organisation that had run LINks were successful in bidding to become a local HealthWatch while in others Local Healthwatch will be run by a new organisation.

While maintaining its leadership role, The Department of Health will from April 1st no longer directly manage NHS organisations. Some of this function have been passed to the NHS Commissioning Board, which will oversee CCGs and will agree their funding. This, in theory, shifts decision making outside of government for the NHS, although the Secretary of State for Health, currently Jeremy Hunt, retains the ultimate responsibility for the overall system. The organisation, Monitor, has the role of regulating all of the new structures of the NHS. They will also from 2014 be the body that approves and provided licenses to bodies both NHS and none-NHS that provide services to NHS patients. Along with the NHS Commisisoning Board, Monitor will also be responsible for setting the pricing of NHS services to work out the cost of patient care from 2014/15.

The reorganisation is the result of the changes to the ways in which health and social care is to be delivered brought into effect by The Health and Social Care Act 2012. The Act had a long passage into law under the leadership of the previous Health Secretary Andrew Lansley, and the changes that it has created still divide opinion. While Social Care is included in name in these reforms; a Care and Support Bill which will clarify future structures is currently at draft stage.

If you’re interested in young people and mental health, here’s your weekend reading sorted….

As some of you may know, One in Four editor Mark Brown has been working on a number of case studies of young people’s mental health and wellbeing projects for Right Here, the five-year, £6m initiative young people’s mental health and wellbeing project jointly managed by the Paul Hamlyn Foundation and the Mental Health Foundation running from 2009 to 2014.

Each of these four case studies is a summary of a mental health and wellbeing project commissioned and/or run by young people.

The four case studies are:

What if young people tried to change the way GPs treat them?

Young volunteers with the Right Here Brighton and Hove project decided that good research and persuasive presentation were better than just complaining. A case study of the activities of Right Here Brighton and Hove.

Boxing clever?

An unusual mental health and wellbeing project in east London is using boxing to help young people get sorted. A case study of a project using boxing to reach vulnerable BME young people in Newham, commissioned by Right Here Newham

Who looks out for young mothers?

Case study of a year long young mother’s group in Enniskillen run by Right Here Fermanagh, a partnerhship to improve the wellbeing of young people led by Youth Action Northern Ireland as part of their work around mental health early intervention with 16-25 year olds.

A not so trivial pursuit

There’s also a couple of bonus pieces, one about young people’s experiences of violence violence called, erm, ‘Young people and violence’ which is based on the findings of Right Here Newham about the lives of young people in Newham, Inner London and a summary of the Right Here project’s showcase event ‘A Voice and A Choice’.

Happy reading!

Mark Brown has been wondering about where the ‘battle against mental health stigma is now’ and where it might be going next

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A photo of someone I'm not as funny as

We talk about stigma a lot when talking about mental health difficulty, or at least some of us do.  A stigma is, strictly speaking, a physical mark of disgrace.  It’s something inflicted on a person’s body by a society that is understood by that society both as a punishment and a warning.  The thing is, mental health difficulty is something that happens in your head.

Erving Goffman described stigma as “The phenomenon whereby an individual with an attribute is deeply discredited by his/her society is rejected as a result of the attribute. Stigma is a process by which the reaction of others spoils normal identity.”

So what is it we’re stigmatising? What is it we’re spoiling? I think there’s two possible things we’re stigmatising: the behaviour of an individual and the way in which their condition affects their life. In having a mental health difficulty there is the direct consequence of what you experience and then, following from that, there is the effect this has on you, your life and the lives of those around you.

Anti stigma: Inspiration or corrective?

At present we’re at the beginning of a concerted effort to attempt to reduce stigmatising behaviour towards people with mental health difficulties.  National multi-year campaign Time to Change is both creating the impetus of this wave and riding it by funding grassroots anti-stigma activities, promoting positive media images and trying to drive up ‘social contact between people with mental health difficulties and people who do not.

Anti-stigma work in mental health, including Time to Change, has recently focused much on inspirational stories and role models or positive examples of people with mental health difficulties doing things.  The logic is that bad implications of mental health difficulty can be refuted by providing a positive image in opposition.  Early attempts at this kind of action tended to rather clumsy: ‘You think people with mental health difficulties are lazy? This man built the world’s largest shed!’

It’s often hard to tell whether an individual story is meant to be inspirational to people who already experience mental health difficulties or to mainly act as an answer to an existing stereotype about people with mental health difficulties.  Sometimes it feels that campaigns try to kill two birds with one stone, such as in the recruitment or publicity of celebrities who experience mental health difficulty.

It’s easy to fall back upon the inspirational story as the main way in which to tackle poor attitudes towards people with mental health difficulties.  The problem with the inspirational story, or indeed the celebrity story, is that it individualises mental health difficulty and, while seeming to appeal for greater acceptance, can inadvertently compound the idea that mental health difficulties are individual failings which may be overcome with a combination of vim, vigour and good humour.

The thing is, sometimes having a mental health difficulty is awful. Or embarrassing.  Or disruptive. Or can make you unemployable. Or turns your house into a mess. Or any of the other unpleasant things having an impairment to your mood, behaviour, thoughts, perceptions or motivations might cause if you don’t have some sort of aid to offset it.

Obscuring real needs

I’ve been wondering whether it’s possible that we are managing to obscure the real implications of having a mental health difficulty by focusing on ‘accepting the person’ while, as some would claim, erasing the circumstances under which they live?  And, as a result of that, are we failing to focus on what might reduce the impact a mental health difficulty has on the lives of people by being unable to see what adaptations and modifications might be made to situations?  In other other words, are we focusing too much on the idea that individuals are ‘judged’ by society and not enough on what it actually is that’s being judged?

The criticism of the foregrounding of celebrities in mental health acceptance campaigns is that the celebrities do not, in most ways, reflect what people are being asked to accept of other people with mental health difficulties.  Some people with mental health difficulties frame this defensively, seeing the celebrity with mental health difficulties as a failed inspirational figure who is targeted at them.  This might be termed ‘You’re not as funny as Stephen Fry’ syndrome.  This view goes as follows: the celebrity is being held up as an example of ways in which people with mental health difficulties can overcome their impairments and be successful.  The celebrity, though, has access to more advantages and material aids than an average person with mental health difficulties, therefore is a misleading guide to what ‘the public’ may expect from people with mental health difficulties in their lives.

If we step away from the personalising and relating to own circumstances in that argument, we are left with the core idea that what people are being asked to accept about mental health difficulties is that people have them, but aren’t being asked so much to consider what the implications of those difficulties and impairments actually are.

The reason why the use of celebrities with mental health difficulties by campaigns gets on people’s nerves is because people feel that their use involves asking the public to accept what they have already accepted.  They already know and like the celebrity, they are fairly aware of the various aspects of their story.  They accept that they have a degree of legitimacy as a person; they have, after all, succeeded enough to be famous.  This obscures the fact that for people with mental health difficulties to find a real advancement in our circumstances, we are not only asking for ‘the public’ to accept that people have mental health difficulties, but to also accept the effects having a mental health has upon people’s lives.

Accepting a person, ignoring a situation?

Mental health difficulty is a series of impairments.  These impairments have real implications for what any individual needs to live a viable and fulfilling life.  At present we are, to my mind, extremely bad at addressing that impairments cause needs which in turn cause outcomes when those needs are not addressed.

We know that having a mental health difficulty tends to make a series of social outcomes more likely for us.  We also know that different mental health difficulties tend to make different messes of your life.

I like to think that we are merely at the ‘coming in from the cold’ stage of mental health awareness; the initial stage of raising the idea that people with mental health difficulties are discriminated against and stigmatised.  On that basis, I think we need to see current campaigns and understandings as a transitional stage on the way to a better settlements for people with mental health difficulties.

But where are they a transitional stage on the way to?

At the moment, the idea of challenging stigma and the idea of making things better for people with mental health difficulties are viewed as synonymous, but I’d be very worried if this linkage were to continue indefinitely.   The danger is that we split into two mental health worlds, one involved in attitude change work and one that tangles with and knows how mental health difficulties play out ‘on the ground’.

For me, what’s holding us all back is being unable to stake out the ground for an exploration of what impairments mental health conditions cause and what we can do to assist and mitigate against those impairments.  I think this is the natural next stage after our current period of foregrounding the anti-stigma struggle – the shift from saying ‘accept people with mental health difficulties exist’ to ‘accept that we need to make changes to the way things are so that people with mental health difficulties are no longer excluded’.

I draw no comfort from ‘accept that it’s an impairment having a mental health difficulty’.  I have one.  I know that.  I’m more excited by the question of ‘how do we reduce how much the impairments presented by mental health difficulties actually disable someone?’

Can we get from saying ‘be nicer to people with mental health difficulties’ to reducing the mess that having a mental health difficulty makes of your life?

Then what?

Mark Brown is the Editor of One in Four magazine.  He is @markoneinfour on twitter

Below is the editorial from this Winter’s One in Four magazine summing up 2012

As we go to press Chancellor George Osbourne has just announced in his Autumn Statement on December 5th that austerity will continue in the UK for at least another 5 years. Cuts to services, economic slowdown, worries about rents, jobs and changes to benefits, all collide to make for a somewhat shaky sense of security. Many of us will look back on 2012 as a difficult year.

The issue of mental health found itself in an interesting place in 2012. In a broad sense, 2012 has been the year when mental health went mainstream, or at least certain aspects of it. As mental health tweeter @sectioned_ notes on page 20, mental health is finding its place within the wider issue of disability as a niche political issue. As we see in our coverage of the Mind Media Awards on page 19, mental health is also breaking out of its dull-but-worthy ‘issue’ box and finding its way into mainstream, prime-time programming. The Commons debate in June where MPs discussed their own mental health difficulties was a significant event, as we noted at the time, as have been the increasing number of celebrities ‘revealing’ their struggles with their own mental health. Channel 4′s ’4 Goes Mad’ season stoked a short-lived flurry of discussion around mental health. The NHS mandate (see News) also can be seen as a major step forward, with the government specifically asking the NHS to give mental health the same esteem as physical health and to bring things like waiting times and choice in mental health in line with experiences in physical health. On one level, 2012 has been a year of progress. The issue of mental health has managed to get into the high-flying world of Westminster politics and air-kissing media. People have been talking about mental health, but have they been talking about the right things?

Out on the ground, the feeling of 2012 has been slightly different. Many people with mental health difficulties feel under threat from cuts in services, shrinking budgets, changes to benefits and a hardening attitude towards social security and the Welfare State (see News). With the economy failing to pick up and local and national government making tough decisions and even tougher noises, many with mental health difficulties have been on the receiving end of a huge dose of destabilising change. As we see from Fabio Zucchelli’s experience of moving from working for the NHS to using the NHS (see page 8 ) progress isn’t a uniform business. There are still many areas in the experiences of people with mental health difficulties that aren’t moving forwards as quickly as we’d like. The consequences of austerity and economic depression have fallen heavily on people with mental health difficulties, many of us who were low on resilience and reserves even before the current challenging times began.

Changing law and fighting for the things that people need to have a good, safe and fulfilling life is vital, but it’s not something you can do all of the time. We can’t stay angry and afraid from the time we get up to the time we go to bed. Sometimes we need to have fun. For some of us the Olympics and Royal Wedding presented a welcome respite from worry.

Our lives are a constant interplay between big events that touch the lives of millions and the tiny things that just affect us, our communities, our families and friends. It’s important to remember that as much as it’s important to take on the big fights and big issues; it’s also important to nurture the things in our own backyard, too. Fun and pleasure isn’t an optional extra, nor is companionship, love and fellow-feeling.

If there is one thing that became clear in 2012 it’s the fact that people with mental health difficulties need each other, and our allies, more than ever.

Here’s to 2013.

Mark Brown, Editor

This editorial appears in the Winter edition of One in Four magazine, out January 2nd. Mark Brown is @markoneinfour on twitter

This week the Department for Communities and Local Government (DCLG) launched a document 50 ways to save: Examples of sensible savings in local government a compendium of ideas for cutting the amount of money that councils spend. Some are sensible, others are more contested.

One that caught the eye of Karl Wilding, Head of Policy for the National Council for Voluntary Organisations (NCVO) was recommendation number 37. It’s worth looking recommendation number 37 in more depth because it may have implications for mental healths service user groups, or at the least smears their name a little. It suggests:

“Cease funding ‘sock puppets’ and ‘fake charities’: Many pressure groups – which do not deliver services or help the vulnerable – are now funded by state bodies. In turn, these nominally ‘independent’ groups lobby and call for more state regulation and more state funding.61 A 2009 survey found that £37 million a year was spent on taxpayer-funded lobbying and political campaigning across the public sector. Many of these causes may be worthy, but why should they be funded by taxpayers?”

The term sock puppet is a confusing one if you’re not a veteran of internet message boards. In that context a sock puppet is an account set up by someone under another name to contribute to discussions in such a way as to support the points made by that person under their primary account. You can spot sock puppets in online discussions quite easily; they will usually only comment where a particular person comments and then only to agree with that person or to attack someone who disgrees with them.

So what relevance has this to the funding of mental health service user groups by local authorities?

This is interesting for us in mental health because, up until this point many mental health service user groups have drawn at least some funding from local authorities and have often seen it as their role to hold to account and to lobby for the interests of people with mental health difficulties. Would these count as sock puppets?

In support of the idea of “’sock puppets’ and ‘fake charities’” the document cites a discussion paper by Christopher Snowdon produced by the Institute for Economic Affairs Sock Puppets: How the government lobbies itself and why

The executive summary of the discussion paper suggests says government spending on civil society (or the third sector if you’re keeping it pre-2010) grew massively during the period that Labour held office between 1997 and 2010 and thatt this erosion of autonomy is bad for society as charities stop representing people and begin to act as a ‘shadow state’ of things funded by the state but which aren’t part of it.

This is an argument that many have made from different positions in the political spectrum. But that’s not about sock puppets. Sock puppets are mouth pieces of political interests, the paper has it, and

“This paper argues that there is a deeper problem if government funds and/or creates pressure groups with the intention of creating a ‘sock puppet’ version of civil society which creates the illusion of grassroots support for new legislation. These state-funded activists engage in direct lobbying (of politicians) and indirect lobbying (of the public) using taxpayers’ money, thereby blurring the distinction between public and private action.”

So, for Snowdon (and the DCLG it seems) ‘sock puppet’ charities are charities that campaign on certain issues and which call for greater government action over particular issues. The discussion paper says:

“State-funded charities and NGOs usually campaign for causes which do not enjoy widespread support amongst the general public (e.g. foreign aid, temperance, identity politics). They typically lobby for bigger government, higher taxes, greater regulation and the creation of new agencies to oversee and enforce new laws. In many cases, they call for increased funding for themselves and their associated departments. In public choice terms, they are ‘concentrated interests’ compelling the taxpayer to meet the costs that come from their policies being implemented, as well as the costs of the lobbying itself.”

Karl Wilding wasn’t happy with this. He told Third Sector:

“”The sock puppets report is terrible: it’s badly researched and it vastly overstates its case. We know that most funding from government for voluntary organisations is for the delivery of services, not for advocacy and certainly not for lobbying government.

“I think it’s particularly disappointing to see this recommendation at a time of year when many local authorities are thinking about their budgets for next year and therefore thinking about their relationships with the voluntary sector.”

Nestled as it is within 49 other suggestions to local authorities for saving money, it’s easy to overlook what the implication of recommendation 37. If the DCLG means sock puppet in the same sense that Christopher Snowdon and the Institute for Economic Affairs means sock puppet; it is suggesting that councils should feel free to stop funding groups that represent minority interests and ones that either do, or don’t lobby for change in particular areas.

Fair enough, you might say, why should local authorities fund people to disagree with them or waste money funding people to agree with them; especially if they are taking forward issues that are not of interest to the majority of people?

But where does this leave locality based mental health organisations? Small locality based mental health organisations, including service user organisations, have seen their role as collective advocacy primarily, with delivery of services second. The argument for why your local council should fund a small mental health campaigning / service user group /collective advocacy has often been that other sources of funds are not easy to come by and that if the council thinks mental health is important, they should stump up some cash.

Some would argue that mental health groups and organisations that are trying to change conditions, systems and services should not be funded by any state money for reasons of independence and political autonomy (Snowdon’s lead-off point is just that). This recommendation from DCLG seems to suggest that local authorities should not, on principle fund something like a local mental health forum or service user group because they are either a)paying someone to agree with them or b)paying someone to disagree with them.

Traditionally, mental health advocacy groups have campaigned for greater allotment of funds to mental health and greater provision across a number of areas covered by local authorities. Now, with the rejigging of responsibilities begun by the passing of the Health and Social Act local authorities are increasing involved with health as well as social care. There is much commitment to user voice in these ideas, but it seems the DCLG has set a trap for organisations that support service user voice by introducing a way of discounting as ‘sock puppetry’ or the need to avoid appearing to create it any request for money that they may make to continue their role raising awareness and pushing for better or different services.

As with much of the stuff that floats out from central government in terms of ‘helpful guidance’ under any government, the chances are these 50 recommendations will only speak to the people who already agree with them, so will have limited direct effect. Politically, though, the 50 ways to save are part of a struggle about what responsibilities governments, and by extension taxpayers, have to pay for certain things.

It seems that DCLG is suggesting that local mental health organisations, those keepers of the flame of a minority interest (the interests of people with mental health difficulties) might be getting an even colder shoulder from their local council than they did before.

It seems like socks for Christmas is just as much of a crap present as it always has been.

Mark Brown is the Editor of One in Four magazine.  He is @markoneinfour on twitter

The following is the text of a speech delivered by Mark Brown exploring The New Mental Health delivered at Leeds Mind’s 40^th Birthday celebration on October 3^rd 2012

These are interesting times. It brilliant to be somewhere that’s celebrating something…

It seems virtually impossible to get through a day without some new bit of bad news: cuts to benefits, cuts to services, job losses, ever more draconian benefits tests, economic instability both at home and across seas.

We’re in the midst of the sharpest contraction of public spending in decades and we’re just at the beginning if our current government is to be believed.

It’s quite easy to feel that everything is falling apart and that every day is worse than the last, but I think there are glimmers of hope on the horizon. Well, not just on the horizon but all across the country, in Leeds, in fact anywhere where people with mental health difficulties are deciding to take forward our own projects and organisation under our own steam and with our own ideas and values. I call this The New Mental Health.

The New Mental Health is about people with mental health difficulties using our own skills, ideas and experiences to make and run our own organisations, projects and services, sometimes finding better ways of doing things that traditional services have done, sometimes doing things that are completely different. It’s not a movement so much as a shift in thinking. If there’s one thing that The New Mental Health asks it’s ‘what if people with mental health difficulties just went ahead and did things for ourselves?’

I’m going to define The New Mental Health in more depth in a moment, but first I want to look at where we are now.

Where we are now

More than ever people with mental health difficulties are finding ourselves in situations that would probably not have happened to previous generations. We’re running into questions that don’t have established answers.

As a result of the hard work and campaigning of the individuals and organisations that came before us, people with mental health difficulties now are more likely than previous generations to have a job, have kids, have interests, to have the things that we’d recognise as ‘having a life’.

This awareness of people with mental health difficulties as something other than just a problem to be solved, and our awareness of ourselves as groups of people with differing needs and wishes, didn’t exist when the NHS was formed. Treatment and support was provided along industrial lines, with mental health services providing one-size-fits-all treatments and support.

As we get more successful at challenging the idea that having a mental health difficulty is somehow a diagnosis of doom that means we have to give up hope of ever having a decent life, the more clearly we can see that the needs and wishes of people with mental health difficulties are changing more quickly than a rigid service delivery can accommodate. This is a step forwards.

However, this step forward is happening at a time where budget cuts and other forces are making it more difficult for larger organisations to focus on anything other than the most severe of needs. In many places, some of the established parts of the mental health landscape are under threat if they haven’t disappeared already.

So we’re looking at a situation, for the time being at least, where traditional services are being stretched and, in some places, disappearing while what services there are struggle with the fact that the way in which they deliver help and support doesn’t quite fit with the lives that people with mental health difficulties actually have.

Many of us find ourselves campaigning to try to save services that, if we’re honest with ourselves, we don’t actually find that useful because they don;t quite fit what we need.

People aren’t accepting that they are ‘just’ service users. We want to do something. We want to help sort out some of the problems that we’re seeing in our communities.

What someone who is seventeen needs to help them get through life hearing voices isn’t the same as what someone who is thirty nine needs to help them get through life hearing voices. What someone taking refuge in the UK from a war ravaged country in Africa needs to help with their anxiety isn’t what someone who is a manager of a small company making window frames needs to help with anxiety.

While people may have the same symptoms, they don’t have the same lives.

For many of us, the focus of our attention has shifted from medical services as the sole provider of help, support, advice and treatment – We know that medical services are vital to help us get well, but they aren’t what helps us to keep well – And we’re asking ‘if we do want help to make our way in the world, who is going to give it?’

And, for The New Mental Health, the answer is often ‘ourselves or people like us’.

So what is The New Mental Health?

The change I’m calling The New Mental Health is not so much a movement, but a broad range of projects, organisations and services that are moving in similar directions. The New Mental Health tends to look at the bits of people’s lives that lie beyond the consulting room, the ward and the clinic. It doesn’t tend to see its activities as making symptoms better but making lives better. The shift I see as The New Mental Health is people with mental health difficulties just getting on with making change happen.

Broadly, the defining characteristics of the new mental health are:

• The New Mental Health is pragmatic not ideological
• The New Mental Health blurs the old boundaries between people who provide services and people who receive them
  

• The New Mental Health come from outside of (in the UK), the NHS or large providers
  
• The New Mental Health is not usually about campaigning
  
• The New Mental Health works with non-medical aspects of people’s experience
  
• The New Mental Health constantly struggles for existence
  
• The New Mental Health is not still fighting old wars
  
• The New Mental Health is directly responsive to needs, and
• The New Mental Health generates real opportunities for people

One of the important qualities of the New Mental Health is that it is pragmatic and focuses on getting things to happen by which ever method is best. It isn’t hung up on a particular form of organisation or in fighting ideological battles. It doesn’t turn it’s nose up at the idea that social enterprise might be the best method of making things happen. It isn’t scared of getting in there an making its case. It spots gaps and it tries to fill them. People with mental health difficulties are the people best placed to see where something isn’t happening or to see where something new could happen to great effect. The New Mental Health is about working out how to make that something happen.

Traditionally services in mental health are provided by professionals without experience of mental health difficulty for those that have. The new mental health is often developed and delivered by people with direct experience of mental health difficulties. In the case of my own company, I have a mental health difficulty. My co-director David doesn’t. In the case of One in Four the mental health magazine we publish, all of the writers have direct experience of mental health difficulty. I’m not a service user supported by my ‘normal’ colleague.

Practices like co-production and peer working bring the ‘service users’ to the same table as the service providers. This changes things. Working with organisations run by people with mental health difficulties means that organisations can’t have one voice to talk to ‘service users’ and one voice to speak to professional peers. Suddenly the people who have direct experience of something are the people who you work alongside rather than ‘those people over there’.

Very often the New Mental Health comes from outside of large providers. There are a number of reasons for this. The first is that coming from a background of lived experience, organisations run by people with mental health difficulties recognise gaps and opportunities that large providers don’t. That’s because they start from a very direct knowledge of what problems people face and a personal understanding of where people’s aspirations differ from the menu of opportunities that is on offer from established sources.

When we started One in Four, I drew on my own experience of mental health difficulty and specifically my own experience of how uninspiring and bitty information about mental health was. We started from the point of asking ‘what do people with mental health difficulties want to know?’ rather asking ‘what does our organisation have an obligation to tell them?’. Across the country people are spotting similar things based on their own knowledge and situation.

The second reason that the new mental health comes from outside of large providers is that often the new mental health is in some way disruptive of established ideas or ways of working.

The third reason is that large providers don’t employ as many people with experience of mental health difficulties as they should. It is a very different thing to be employed specifically as peer worker by a large provider to being a peer worker in an organisation that is run and managed by peer workers. Within larger organisations it is possible for people with mental health difficulties to drive through innovation, but it doesn’t happen as often as it should.

One of the qualities of the new mental health that challenges traditional ideas about service user groups is that the new mental health is more about doing than it is about campaigning. Campaigning is asking one group (maybe a particular service, maybe the general public, maybe the government) to do something on behalf of another. There is always room for campaigning, but the new mental health is about doing. It’s about recognising a gap and deciding to try to fill it for yourself and your community. It’s a shift from saying ‘someone needs to do something about this’ to saying ‘we’re going to do something about this’. The way things are at the moment, that gap might be there because a larger organisation doesn’t have the budget to fill it anymore.

As we’ve established, The New Mental Health isn’t so much about the medical aspects of mental health, but meeting the needs that people with mental health difficulties have that aren’t medical. The New Mental Health might not be able to cure you of any symptoms you have but it might provide you advice, support, activities, friendship or even a job.

Within The New Mental Health organisations and projects often struggle financially for their very existence precisely because they’re new and are coming at mental health from unexpected and untried angles. This can make it difficult for them to find funding because they do not fit traditional ideas of what organisations should be like but also that they do not fit traditional ideas of what people with mental health difficulties are looking for from services or projects. These organisations can be ahead of the curve of innovation. This means that their understanding of the needs, aspirations and wishes of people with mental health difficulties can be in advance of the existing fixtures in the landscape. In its favour, though, The New Mental Health can often get far more value from any money it can secure and can use it far more directly making things that people want to happen actually happen.

One hallmark of the New Mental Health that brings it into conflict with existing service user organisations is that it is not as interested in redressing the injustices of the past and tends not to have campaigning as a main focus. There is a limited amount of time in each day, and The New Mental Health tends to get on with trying to solve the problems that it sees. Sometimes we are held back in mental health from developing new ways of meeting needs because we fear that if we find solutions to our problems ourselves it means that we will play into a political trap that is looking for arguments to remove money from our sector forever. There is room for both campaigners and do-ers in mental health. Campaigning against cuts in benefits is desperately important, but so is setting up a local support group for the people that are experiencing them.

When the New Mental Health thinks about changing things it tends to be pragmatic and start from looking at what can be changed in the here and now. Where it works, through necessity, it tends to start small and to meet the needs it finds directly. This is because it tends to grow from identifying a particular problem that a particular group of people have rather than attempting to find an answer that will work for everybody. It’s also because The New Mental Health tends to spot gaps in areas that have experienced cuts or which have been ignored.

The New Mental Health also generates opportunities for people with mental health difficulties by creating things that we have a stake in and which we can influence and feel part of… Would you rather be an involved service user or someone working for a mental health organisation? Which is more likely to look good on your CV and generate opportunities in the real world?

Now we’re going to talk about the The New Mental Health in action

There are a number of organisations and groups run by people with mental health difficulties across the country that fit within The New Mental Health and which share most of the traits I’ve outlined. There’s some in Leeds. There’s Cooltan Arts in London who’ve been doing excellent art projects for years. There’s Launchpad in Newcastle, run by people with direct experience, who’ve successfully delivered a whole range of projects over a number of years, there’s Tea and Talk, mental health awareness with a twist, but I wanted to give you a small example of what The New Mental Health looks like in all of its learning by doing glory.

There’s a group of people with mental health difficulties called Ubuntu in the area where we’re based that were at one point the users of an arts project funded by the local trust. It was an expensive project, with full time OTs and other staff. When it ended they decided that they wanted to carry on delivering arts projects themselves. They lobbied the council and the trust for money to keep going; a small community group of people who just wanted to make art happen. The council managed to find some money to keep arts activities going under the old project name. Nowhere near enough to run the project in the way it had been run before, but enough for a committed group of people to make lots of stuff happen.

In an hilarious example of council bureaucracy getting in the way of making things happen, the money was put out to tender. Our plucky gang of people with mental health difficulties put in a very creditable bid for the money but the money went to an established local arts organisation. They still haven’t spent the money.

Did our local group give up? No. They kept going, kept delivering arts activities subsidising it out of their own pockets, borrowing space from other organisations. They knew that what they were doing had value and was worth while and was different from what an established organisation would provide. Together, as a group, they knew what they wanted and what other people with mental health difficulties would like too. They turned their community group status into a virtue. They decided that not having an office was a good way to keep costs down. Because they kept their eyes on doing something good, talked to other people who could help and didn’t wait for other people’s permission to do what they knew they and others wanted, they’ve managed to stay around long enough that someone has given them a small grant.

Are they going to be able to solve all the problems of people with mental health difficulties in our local area? No. Are they going to change the entire world and develop a massive multi-million pound empire? No. But they are going to be able to provide arts activities for people who really want them at a time and in a place where no other arts activities run by people with mental health difficulties exist. And who knows what might happen a little bit further down the line…

That’s the kind of thing The New Mental Health is about – spotting a gap, finding resources and making something happen. And you can bet that with people with mental health difficulties in charge, that something happening will look and feel different to what would have happened if the big, traditional service had stayed around to provide it.

It doesn’t just have to be arts activities, though I’ve heard a rumour(!) that there’s quite a bit of that going on in Leeds at the moment. As I’ve said, traditional services have been good at providing treatment, but there’s far more to having a decent life with a mental health difficulty than treatment. What people need is stuff that makes life worth living, and that’s where The New Mental Health steps in. It’s people with mental health difficulties doing and making stuff for other people with mental health difficulties that makes life better; and who better than us to know what that stuff might be?

Is the New Mental Health happening everywhere? Not yet. It happens in small isolated pockets where conditions are right and individuals and organisations break through the old understanding of mental health and decide that just being a service user isn’t good enough.

So what does The New Mental Health need to thrive?

At the moment, bigger organisations have all of the money, all of the staff and all of the resources, even if they don’t feel like they do. The New Mental Health needs people prepared to believe in it, support from people inside services and communities outside them, some cash and resources to make things happen and recognition that it represents something different.

One challenge that The New Mental Health always faces is the old one of stigma. Having come to doing stuff as ‘service users’ or ‘people with mental health difficulties’ we find it very difficult to escape from that pigeon hole.

Just because someone has or does use a service does not mean that they can never be involved in delivering a service themselves.

I have coined a verb: to beneficiary or to be beneficiaried. This describes the chilling moment in a meeting or professional situation when someone realises that they aren’t just talking to a professional peer but ‘one of those people with mental health difficulties’. You can feel them drawing back, thinking ‘on no, I thought they were a proper professional’, putting on their best talking to patients face… Still happens to me.

If you work for an organisation, The New Mental Health will come and find you as many times as you go looking for it.

Established organisations may not have budget to give away but they have something just as important: resources and knowledge. In every organisation there is a storehouse of experience in running projects, securing funding, meeting challenges. Leeds is one of the places that I hold up as an example of people being prepared to share what they know so that things can happen. Larger organisations have buildings, spaces and other assets that they can use to support local projects even if they can’t find any budget to do so.

If you have a problem convincing the powers-that-be that supporting local groups run by people with mental health difficulties is vital, think about this: One of the important bits of the recovery model is defining your own outcomes and finding a role and meaning in your life. There is an obvious argument to be made that an organisation that has seen you primarily as a patient may not be the best organisation to support you to not see yourself as one.

To really help people move beyond being service users we need to make sure that there is enough variety, choice and self-determination that they don’t turn into just service users.

I’d argue that the new mental health, that is, the idea of people with mental health difficulties taking control directly of making services and running services is the natural next step from the recovery model. The new mental health, building on the recovery model, realises that, actually, when you think about it, maybe what people need to get on with their lives is something that might not actually come from traditional services at all.

There’s loads more I could say about The New Mental Health, but I’ll leave you with this:

Aside from all of the things I’ve already mentioned, can you guess what The New Mental Health most needs?

It needs us, people with mental health difficulties, to look around at our communities, find something that we want to change, take a deep breath, think about all of the challenges lined up against us, shrug our shoulders, give a cheeky wink and say ‘sod it, we’re going to do it anyway.’

Thank you!

The people behind One in Four (us) are launching a new project in Hackney to get a mental health newsletter off the ground in the London borough of Hackney.  The project starts October 10th.

Here’s the details.  Please share. Also if you work for a Hackney mental health organisation get in touch!

Hackney Mental Health Newsletter project

Would you like to join the editorial team for a new newsletter about mental health in Hackney?

Do you want to help tell other people with mental health difficulties what’s going on in the borough?

Want to write and research things that’ll help other people find support, understand more about mental health services and get the most out of life?

The newsletter will be produced by people with mental health difficulties for other people with mental health difficulties.

You’ll get to learn or use journalism skills including:

• Feature writing
• Interviewing
• Editing

Weekly editorial meetings – Wednesdays 2pm – 4pm – at Centre for Better Health, 1A Darnley Road, London, E9 6QH

For more information call 020 8521 7956  or email hello@socialspider.com