Author Archives: mark

It’s impossible to talk to anyone involved in mental health at the moment, whether as a user of services, a planner of services or as a deliverer of services without one topic cropping up.

Everyone is asking the question ‘Where’s the money going to come from?’

So far, so familiar.  Mental health has always been an area where money is tight.  However, there’s a new urgency since the effects of deficit reducing cuts began to be felt.

It’s instructive to think about this question in a slightly different way.  Rather than asking ‘where will the money come from?’ it’s more interesting to look at the question as being ‘just who is going to pay for services in mental health?’

Prior to the advent of the coalition government, for many people the answer to this question would have been simple.  Either the state in one form or another would be paying as part of the public services, through directly contracted services or through strategically awarded grants.  If it wasn’t the state paying, then the answer would have been grants made by charitable organisations in one form or another.

Very rarely would the answer to who was paying be people with mental health difficulties themselves.

By their nature, mental health related services are based on the idea that services are being provided to those that need them but who would not be in a position to pay for those services themselves.  When a mental health service is funded by, say, a local authority what is happening is that service is being bought on behalf of the people who use it to meet their needs.  When a service is funded by a grant funder, the same is happening.  The funder is recognising a need that will be met by the proposed funded service or project and is putting up the money for some or all of that service to be carried out.

In both cases, the service is being purchased on behalf of people with mental health difficulties.

In the NHS, this process is repeated.  Commissioners put into action strategic plans to meet the needs of people with mental health difficulties by commissioning services while managers allot funds.  In essence, they are again buying services on behalf of people with mental health difficulties.

Many would say that for medical based services, it’s the NHS who should be providing and that for everything else there should be grant based funding.  For organisations such as The National Coalition for Independent Action, voluntary sector groups and organisations chasing contracts to deliver what local authorities have decided is important has reduced their independence and ruined their relationships with the people who use their services and the communities in which they’re based.  As Rachael McGill says in NCIA’s recent report Voluntary action under threat: what privatisation means for charities and community groups:

“Some voluntary sector organisations have helped to further this agenda by entering into competitions to deliver services on their local authority’s terms. They fail to recognise that although they themselves are not the private sector, they are still conspiring with a practice which turns community provision into a market place.”

The NCIA paper claims that this is a significant step towards eventual privatization of public services:

“The coalition government has embraced this conflation of ‘charity’ and ‘business’. It wants to institutionalise the idea that the preferred way to fund traditionally charitable activity is through social enterprise methods: loans and income generation through contracts, charging or trading, rather than grants or other public subsidies.”

While this point may or may not be true in principle, it does leave the massive question of who will be paying for the provision of services.  In the appendix to Voluntary Action Under Threat, there is an attempt to suggest ways that this might be brought about beyond campaigning against cuts (changing policy):

“Can we lobby independent funders to support needs-led work, preventative and holistic work and campaigning?” the report asks.

Which delivers us back to the question: just who should be paying?

It isn’t who’s selling, it’s who’s buying

Social Enterprise is often presented as a solution to problems that community and voluntary sectors are having financially.  Set up a social enterprise and you’ll be able to do business and raise money at the same time as doing good. We recently met with someone from a major social funder who was looking for social enterprise models in mental health for investment.  We thought about this a lot and advised her that there were fewer social enterprises in mental health than you might imagine, and those that we did know of were facing significant challenges.

The reason for this, we explained, was that although many people were good at identifying what needs people have and developing effective ways of meeting them, this was not the same as coming up with a winning business model.  The reason it was not the same was not that the social enterprises in mental health were not well run, well structured or not delivering high quality services but that they were lacking one important aspect of any business model.

Money.

Whatever was being ‘sold’; was not, at this time, what people were buying.

Business usually begins by working out what people want to buy and whether it is possible to supply them it in a way that generates profit.  Social action starts from working out what people need and then finding out ways to fund meeting that need.

Social enterprises ‘spun off’ from being previously part of the public sector have the problem that even as spun off services, their main client is the kind of service of which they were once part.  Local charities previously maintained by council grant that become social enterprises have the same difficulty: if the council isn’t paying, then neither is anyone else.

In effect, cuts at a local level close off that large area of revenue generation.

‘But,’ asked the representative of the social funder, ‘isn’t there room for people with mental health difficulties to pay for services themselves?’

We thought about this point for a moment before explaining that for many, the idea that people with mental health difficulties might pay for services out of their own pockets was seen as another step on the slippery slope toward the state providing no support for voluntary and community organisations.  In fact there are those that see asking people with mental health difficulties to pay for services as profiting from the disability of others.

On a less political level, it’s also the case that people with mental health difficulties who need services just aren’t in a position to pay the market price for them.

This makes things very difficult for those organisations that are sticking to their guns and delivering what people with mental health difficulties want them to deliver.

Filling the gap

In the current wash of ideas around The Big Society, there is the notion that with the withdrawal of the state will come a deluge of civic action to fill the space that withdrawal of state funding has left.

This poses us some problems in mental health.  If the state isn’t funding what organisations do either by grants or through commissioning, and people with mental health difficulties themselves are not paying for it directly out of their own pockets, then this leaves three rough areas from where money might come.

The first is from grant making bodies.  This is a tricky area.  For many there is a doubt that mental health is far enough up the list of priorities for most grant making bodies and charitable trusts.  There are few grant making charitable trusts that have mental health as a specific area of focus.

The second is from philanthropy.  Distinct from charitable grant making, philanthropy is the individual giving of time, money or other elements.  Again, as with charitable grant making, it may be possible that individual organisations or projects find patrons who can support their work, but it is not something that it is possible to put in your business plan.  Tech company start ups might be able to find angel investors, but they’re looking for a return on their investment.  Finding rich individuals to fund mental health projects might well be harder.

The third is charitable giving.  It is nice to think that the general public would be happy to raise funds for mental health projects and organisations across the country, and in many cases they do.  This however is an enterprise that benefits from economies of scale.  Organisations need large infrastructures to effectively raise funds from the public, which in turn cost money, which in turn increases the overall need of that organisation to keep pulling in money from the public keep running.  This means that larger organisations have an advantage over small organisations not only in terms of practical fundraising ability and capacity but also in terms of brand awareness and exposure.

The problem is that, as a group of people, people with mental health difficulties are currently not quite at the top of the list of people for which the general public feels worried.  In fact, some might argue that our standing with the public has gone down as a result of media coverage and government policy at exactly the time that we need the public to consider our needs more.

Is there any hope?

There are potential chinks of light coming through the darkened skies, but they are only that at present – tiny slivers of possibility, and it isn’t one that will appeal much to people ideologically opposed to organisations other than the state delivering mental health services or to the idea that organisations must avoid thinking like businesses.

The move to personal budgets both for health and social care present a new possibility for organisations.  For the first time, the theory goes, people with mental health difficulties will be able to draw down a personal budget and then spend that personal budget on buying the services that they want.  No more will others purchase things on our behalf.  In theory we will be able to give money to the services we value and those services will, in turn, try to meet our needs in ever more inventive and satisfying ways.

The problem is personalisation is moving slowly in mental health, and it isn’t clear how organisations will survive long enough for people using their personalised budgets to plug the gap.

What is clear is that for many organisations the clock is ticking, if it hasn’t stopped already.

There just isn’t enough money coming into our sector.  We must strongly advocate for the fact that it should.  We must also be cunning, be charming, be inspiring.  In fact we must do everything we can to bring in that money, from whichever source possible.

Even volunteers need support.

We must by all means make the case for who we feel should pay in mental health, but we also have to be finding out who might pay and finding ways of helping them to do so.

This NCVO / Funding Central advice and information ‘Life After a Grant – The exit strategy’ is useful for organisations facing some of the challenges outlined in this post.

Mark Brown is editor of One in Four magazine and development director of Social Spider CIC.

Wondering what’s coming up in the Summer 2011 issue of One in Four?  As ever, it’s a mix of advice, inspiration, information and a little bit of hope.

Due mid June, you can expect see these exciting articles  in the next issue:

• What effect does experiencing mental health difficulties have on your friendships?
• Work Capability Test and ESA: Navigating your way through the maze
• Un-great expectations: Does how others see us hold us back?
• A report from One in Four’s conference ‘What do we do now? – Mental health, user leadership and communities’
• Our friends in the north: Did you know how different mental health was in Scotland? We talked to Chris O’Sullivan and were surprised
• Supplement on money management support produced with the Money Advice Service
• Seaneen Molloy tells us why she’s a summer Scrooge and why summertime can bring its own blues
• Plus latest news, busting the myth that people with mental health difficulties are lazy workshy scroungers and more including at least one photo of a cake because it’s our third birthday!

If you get there in time you might be able to find a copy of One in Four at your local Mind shop or at a local mental mental health organisation, but to make sure of getting your copy, why not take out a subscription?

Subscribe to One in Four for £10.00GBP per year!

These are belt tightening times.  Cuts, reductions, new forms of contracting, The Big Society…  All of these things and more are making us worry about our ability to make things happen in mental health.

It feels like we are seeing an erosion of what had been provided for people with mental health difficulties.  All we seem to hear of is stories of services and projects running to a stop.

Our conference, taking place in London on the 16^th of May is about looking for ways that we can take forward some of the most exciting and transformative ideas in mental health into this new and uncertain territory.  A lot of us are feeling under siege.  Whether we like it or not, we’re going to be making decisions about how we do things in future.

What if people with mental health difficulties were at the centre of these decisions?  How can people with mental health difficulties and organisations make sure that this happens?

At a very basic level, the conference will be focusing on the ways in which people with mental health difficulties can be the people that drive forward projects and change by either starting their own organisations or working in partnership with other existing organisations and services.  We’ll be making sense of terms like co-production, peer services and user leadership and looking at the ways that these things might be taken forward practically.

If you have an interest in where the world of mental health outside of medical practice might be going next, then we hope you’ll be able to make it.

There’s potential for many of the more exciting and empowering ideas in mental health to meet current ideas like The Big Society halfway.  One strand of the Big Society is about giving more control to communities about the services that they receive, which is something that people with mental health difficulties have asked for a long time.  Another is about finding new ways for the public sector to work with voluntary or community groups, another thing increasingly hoped for by many people with mental health difficulties.

There’s been a lot theoretical stuff spoken about ‘empowerment’, ‘involvement’ and ‘putting people in control of services’ but what does that actually really mean in practice?  We think that there’s a new wave of organisations, projects and groups coming through that blur the line between practitioner and user, expert by profession and expert by experience.  We hope the conference will be a day long opportunity to catch up with and tie together a lot of the ‘next wave’ ideas in mental health with good practical examples of how they’ve been done.

There will also be a Question Time style panel discussion about what the landscape for mental health featuring Andy Bell – Centre for Mental Health, Sarah Yiannoullou -National Survivor User Network, Ceri Jones, Head of Policy – Social Enterprise Coalition and others which will be a good chance to work out just where policy is and where smaller mental health and community organisations might be headed.

There’s also opportunities to meet your fellow attendees and find ways that you might share your experiences and work together.

As a small organisation making our way in the world, we can’t make this (unfunded ) conference free to attend.  Tickets can be bought here and a limited number of bursary places are available.  You can also check the line up.

Hope you can make it!

Cheers,

Mark Brown, One in Four

It’s nigh on impossible at the moment to escape from news stories about the National Health Service and the current government plan to reorganise it.

It won’t have escaped your attention that health secretary Andrew Lansley has called a two month halt to the passage of the Heath Bill through Parliament to listen to the views of NHS professionals.  You can find the web pages for the listening exercise here.

Reading through the Guardian Heathcare Network on the Guardian website I came across this excellent article from The Patient from Hell ‘Will Lansley consult me, the patient?’

It seems that I’m not the only person wondering how the wishes of the people who just use the NHS are going to be reflected in the upcoming changes.  More specifically, I wonder how much the views of people with mental health difficulties will be considered in any future shake ups.

In the spirit of that thought, I’d like to ask for your help.

In the next issue of One in Four, out in June, I’d like to do an article about what we’d like to change about the way we receive treatment and support for mental health.  Rather than focusing on what it is that we don’t like now, I’d like to pitch forward and talk about what we’d like things to be like.  And I’d like to ask for your help.

If you’ve got an idea for how mental health treatment or support might be done better, put it across in no more than 200 words and send it to me at Mark@socialspider.com .

They can be big ideas, little ideas, easy to implement ideas or complete changes f policy.  They just have to make it easier for people to have the best level of mental wellbeing that they can.

You can discuss your ideas here if you’d like to, but please also send them to me via email.

If your idea makes it into the magazine you’ll win a years free subscription to One in Four for either you or a friend.

How does that sound?

Having heard from a few people that there was going to be a demonstration by people with disabilities against cuts to services and benefits, I thought it’d be a good idea to nip down to Trafalgar Square and see what was happening. Head full of scenes from previous demonstrations, I put on an extra jumper and packed supplies of chocolate in preparation for being kettled.

As it turned out, it wasn’t that kind of demonstration. The demonstration, organised by Disabled People Against Cuts (DPAC) was a relatively small affair protesting against cuts in housing benefit specifically and wider cuts for people with disabilities in general.

The demonstration first protested in front of Downing Street before moving on to Trafalgar Square to stage a nativity scene. You can see the donkey and the innkeepers with the names of various local authorities in the photos.

The slogan most chanted by the protesters was ‘Save our benefits, save our homes’, arguing that cuts proposed by government, taken as a whole, put people with disabilities at far greater risk of exclusion.

Protesters were told to refrain from shouting and chanting as the demonstration had not been authorised by The Greater London Authority.

The organisers claim that this is the first of a series of days of action across the country. Brilliantly, people wove through the crowd handing out festive mince pies with a cheerful smile.

It’s interesting to contrast the size of this demonstration with the size and visibility of recent demonstrations about university funding, or the range of flash-mob style actions against high street retailers perceived to be involved in tax avoidance.

I don’t think that it indicates any degree of apathy or detachment amongst people with disabilities, but I think that it does suggest certain differences between any campaign to fight benefits cuts and the campaign against changes in university funding.

One very obvious difference is that students have been better networked. The ease with which large number of people have mobilised is a combination between the fact that university is a place that you and lots of people go to at the same time and the fact that within that there are huge numbers of social and official connections. Add to that the use of mobile phones, social networking and all of the low-cost technology for producing your own media with a very strong overall sense of how the media works, and you have almost perfect conditions to mobilise a large group of people around a particular idea.

Students also have one target for their ire, at least in an overall sense. They are unhappy with the removal of funding from the university system and the suggestion that the balance should be made up by money taken from students future earnings.

In contrast, we people with disabilities are not concentrated in large numbers in particular places, nor do we have the experience of being around large numbers of other people in the same boat as us on a regular basis. Often, we don’t feel ourselves to be part of a wider movement of people, even though we are affected in similar ways by changes to policy and practice in the provision of support.

People with disabilities, including those with mental health difficulties, should they be unhappy with the direction of government policy, are often fighting on a number of fronts which can make it difficult to focus efforts and to engage people. The nebulous phrases ‘disability issues’ covers everything from wheelchair accessibility to employment law reform through medical treatment options to political debates about the meaning of disability. Factor into that the huge variety of ways that people can be disabled, and you have what looks from the outside like a significant minority of the population who experience similar difficulties but who have little in common with each other.

What makes things complicated is that disability isn’t a single issue. Disability in a political sense is the sum total of the life experiences and situations of a huge variety of people. People have varying ideas of what it means to be disabled.

What is common is the sense of living in a world that is harder to navigate than it is for someone who does not experience a disability. I won’t go into the different ways that disabilities pose people challenges in life, mainly because the Office for National Statistics Life Opportunities Survey has done that job extremely well.

Once people accept that a disability is something that makes more difficult doing things you might expect to do, then it becomes easier to see how changes in benefits and government spending might greatly affect those who are currently, quite rightly, receiving a range of support to help them to have what anyone in society might reasonably expect to have.

Students and their supporters have a message that is easier to communicate and which is easier to either agree or disagree with. A campaign by disabled people is more tricky to sell, because it can often take an understanding of the ways in which services and benefits help and support people to be able to see the effect of removing or altering those services and benefits.

It has been noticeable how much less sure footed politicians of all parties have been in discussing the effects of changes to benefits and the implications of cuts to services, which I’m sure reflects the situation in the public at large.

This raises a number of questions.

What would a mass movement of people with disabilities look like? How would it function? What would it do?

And, as importantly, how would people feel about it?

Here’s a video from the day that was posted on twitter:

Mark Brown is editor of One in Four magazine.

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