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