One in Four Magazine

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As Christmas comes and goes and we romp into the dark days of overdrafts and empty nights, crackers and fireworks a dim memory, thoughts turn to taking account and reckoning up.

As I say in the editorial to this quarter’s One in Four, 2011 was not been an easy one for many of us, myself and One in Four included. It was a year where we’ve continually had to snatch hope from the jaws of despair and to find an answer to the question troubling many of us: Just how do you keep going?

In the spirit of reckoning up I’m going to try to answer to John Lennon’s grump-at-the-party cynical idealist question: So this was Christmas, what have I done?

In 2011 I have, in no particular order:

Co-written a thinkpiece Better mental health in a bigger society? was finally published in December by The Mental Health Providers Forum. Originally commissioned by the National Mental Health Development Unit, funded by the NHS Confederation and written by me and my colleague David Floyd it’s our attempt to forge a way forward for people with mental health difficulties in the current policy and economic situation. We think that it’s a continuation of a lot of long held ideals within mental health and a guide, of sorts, for ways to make sure that we as people with mental health difficulties do not lose out from the direction that our country is taking. It stresses that mental health services and local authorities can play a large role in unlocking the capacities and resources to help people to find their own solutions to problems. It also stresses that we’re going to need to come up with new ways to do stuff if we’re going to make sure that mental health needs can be met. We also hope that it catches the fine line between terror and exhilaration that comes when old ways of doing things are in the process of giving way to new things.

Did thirteen weekly creative writing sessions with a great group of folks in Hackney It might come as a surprise to some people reading this, but Social Spider is a small social enterprise with its roots in literature. David my colleague is a seasoned poet, is on the board of Impress, is a editor of a literary magazine and co-runs a small literature venue in his spare time. I’m a published short writer and used to run a creative writing website. This year we did thirteen brilliant sessions of creative writing with a great group of folks in Hackney. Some of them were contributors to a previous project we did in Hackney which generated this small anthology of writing. if you head down to the organisation (The Centre for Better Health) you might just be able to buy a printed copy at a very reasonable price.

Inspired and supported young people with mental health difficulties This year I delivered sessions to young people as part of RADAR‘s Mental Health Young Ambassadors project. I did various things, including advising young people on how to use their own stories of mental health difficulty strategically, explaining how you can keep going trying to make mental health change happen when all the odds seem set against you and how to make sure that you don’t end up being trapped by your own story and status as a person who experiences mental health difficulties.

Delivered a number of sessions of mental health awareness training in the community As part of the pan-London Well London project, I co-developed and delivered a number of sessions of mental health awareness training in the community local to our office in Walthamstow. These ranged from training for the staff of a local credit union and local voluntary sector umbrella body, to a range of volunteers of a local older people services to people with an interest from the local community. It was great to work with people trained as trainers by the Changing Minds programme that began life within South London and Maudsley Hospital and it cemented my belief that the best people to train about mental health are people who have actually experienced it. It also presented me with an interesting insight: Very often the organisations most enthusiastic about having training around mental health awareness are the organisations that already have the best understanding of mental health. It’s the ones that really need a better understanding that are incredibly difficult to interest the possibility of broadening their knowledge of mental health.

Conceived, programmed and delivered a conference In May, we put on a conference called ‘Mental health – What do we do now?’. We wanted to discuss some of the issues, ideas and possibilities that our work on ‘Better mental health in a bigger society?’ and to hopefully begin to build a picture of where we might be going in mental health. It was clear to us that the combined effect of the advent of the coalition government and the concurrent shift in policy and the effects of ongoing financial and economic instability was creating a new landscape in mental health, so we wanted to try to get some of the possibilities that this creates on the agenda as a way of answering many of the challenges it also presents. We got a great crowd of people together, some excellent speakers and sponsorship from both Mind and NSUN. The write up of the conference is here, and includes videos (though luckily none of me!)

Blogged and wrote on mental health in a variety of places Like here, here and here.

Started a mental health forum in Waltham Forest We spotted that there wasn’t really a place for people doing mental health stuff to get together in Waltham Forest, so we decided to start one, the first meeting of which is detailed here. It’s an interesting process, getting people from a range of organisations together to try to discuss what should happen next in a given place. One of the major tensions is between the impulse to get on with stuff, often to fill in for things that haven’t been done by more traditional public sector methods and the impulse to draw the public sector to account for its perceived shortcomings. We haven’t quite cracked it in Waltham Forest, but we’re trying.  I wrote about the first meeting here.

Got out a pamphlet of people’s experience of mental health difficult in the North East Working with a range of people in the north east we did a week of workshops in 2010, and we published the resulting publication in 2011. It’s been distributed across the region and, quite brilliantly, also made it onto the list of a book group at Newcastle Central Library. You can download a .pdf of the project here and check out the organisation, Launchpad, that we did it with here.  (I grew up in Newcastle.  For those of you who wonder how much of my accent remains after years down south, you can survey the evidence in the video below.)

Made four editions of a certain mental health magazine Can you guess which one?

Went innovating with young people as detailed in this blog post

Then of course there’s the ones that got away or, more optimistically, the projects that we didn’t quite get off the ground in 2011 but which might happen in 2012:

A version of a One in Four style project for Scotland Mental health stuff works slightly differently in Scotland, so we’ve long thought it’d be great to do something very like One in Four in Scotland. We’re hopeful that we’ll get somewhere with this in 2012

A young person’s mental health magazine We had a load of meetings and the like in 2011 about trying to get a young people’s version of something like One in Four off the ground which became a bit mired in a series of discussions about whether young people actually read magazines and similar. We still maintain that getting information in the form of a magazine into places where young people actually go is one of the simplest ways of getting good stuff about mental health to people who need it. Don’t get me started on the ‘young people love interactive websites’ argument…

Citizen Journalism Training We developed a way of teaching the range of journalism skills, laws and principles that you need to make good blogs, newsletters, publications and other kinds of investigative writing produced by people who aren’t professional journalists. We tried hard to find groups of people who could pay us a bit of cash to learn that stuff, ut never quite nailed any dates. We’ll by trying that again in 2012.

The New Mental Health… Well, this isn’t quite one that’s got away, but one we’re raising the money for now. If you can take it, here’s a video of me explaining a bit more about our attempt to capture, publicise and disseminate learning from the best and most innovative mental health projects in the country.

I still don’t feel like I’ve done enough. 2011 was a year when I ran hard into my own limitations and where I had to admit that I couldn’t do everything that I want to. There’s still so much that needs to be done in mental health, in a landscape that is changing more rapidly than it has in at least a decade. Hopefully in 2012 I’ll be able to help you do what you need or want to do and I’ll get to the end of the year and think: “Yes, that was the year where I got done what needs to be done.”

Mark Brown is the editor of One in Four Magazine

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If I said to you ‘I spent last Saturday in an innovation lab’ what would you picture? Would you imagine me in a white coat with goggles on, surrounded by bleeping machines and burbling test tubes in an underground research establishment hidden somewhere behind chain link fences? If I told you it was a mental health innovation lab, would you add lots of electrodes attached to heads and lots of machines scratching out brainwaves on rolls of paper?

Well, this weekend I was in an innovation lab and it wasn’t quite like that.

Saturday 10th December saw the first of two Innovation Labs in London funded by Comic Relief, Nominet Trust and Paul Hamlyn Foundation. A development of the young people’s mental health programme Right Here, the aim of the day was to get a load of young people together with some professionals to come up with ideas for ways that technology could be used to improve the lives of young people with mental health difficulties.

Innovation labs and camps have been a fixture of the technology world for a while now. They’re a way of getting people together, getting them thinking and getting them to find ways of taking ideas forwards. It’s a bit like locking a load of creative people in a room and saying ‘you’re not allowed to leave until you come up with something’. There are various techniques for structuring them, many of which seem to involve pizza. The aim is to get ideas flowing, get people involved in them and then to develop something that can be taken forward once the lab or camp ends.

The innovation labs that I was at on Saturday set out to marry the Silicon Valley ‘white heat of technology’ aspect of innovation labs to the solving of the problems that young people with mental health difficulties face. When I went to one of the initial discussion events for these labs there had been a degree of scepticism in the room (not from me I might add). There were concerns that the macho nature of a load of people battling for their own ideas might be too much for young people with mental health difficulties. There were concerns that young people wouldn’t come up with any ideas that could be taken forward. There were also concerns that the whole format disadvantaged people who weren’t natural creative innovators.

Fundamental to these concerns were the tensions between freewheeling creativity on one hand and the idea that solutions to social problems need evidence bases and research and planning, and that the creative response to problems comes at the end of the process of development, rather than at the beginning.

The day was quite tightly structured. After the obligatory warm ups, people attending were divided into four different ‘labs’, each with at least one facilitator and a mixture of young people or ‘younger innovators’ and people who were there in some sort of professional capacity – referred to quite flatteringly as ‘older innovators’. There were about, at most, ten to twelve people in any one lab.

The order of tasks set us was wonderfully sly, and in our lab worked extremely well. Firstly we split into little groups and were given the task of inventing characters based on photographs strewn on the table. I had a hand in inventing a five year old boy named Henry who was the unhappy child of a divorced couple and who had a closer relationship with the people who looked after him than he did with his affluent parents. I also had a hand in creating the character of Geoff, a late thirties deputy head teacher going through a midlife crisis, dying his hair and lusting after one of the cleaners at his school; disillusioned with his life and the loss of his dreams of changing the world, spending empty sleepless nights scouring dating websites after his wife has gone to bed.

Other characters created in our lab included Barbara, an ex sex worker who turned dinner lady and lollipop woman with a heart of gold, Babatunde, a sixteen year old gym addict on the edges of gang culture in London, a jack-the-lad drug using night club door man, a young physically disabled man starting university, and Roxy, a social drug using teen.

Once we’d made up these characters, we got into different groups then thought of scenarios or events that might apply to them. These included things like having an auditory hallucination, finding out a cousin had just been shot or even winning the lottery.

Once we’d done that, we re-jiggled our groups again and started to come up with things that might help the characters we’d created get through some of the challenges with which we’d saddled them. This was where we began to come up with ideas for applications, bits of technology and things that could exist to help people overcome problems.

So, instead of setting out with the task ‘think of a new website’ or ‘think of a phone application’ we came at things from a different angle. We began with people, then really got to know them and work out what made them tick, then we looked at some of the challenges they might face and only once we’d done that did we start to think about what things might help.

We were given about ten minutes in our groups to come up with five ideas. Then we changed groups and had to come up with another five ideas.

We came up with loads of ideas for things. Some of them were websites. Some of them were smartphone applications. Some of them were more tradition text or telephone line based services. A number of them were for additional functions to existing things or online platforms.

We then voted on our favourites which we shared with everyone else from the other three labs in little on-the-spot 30 second pitches.

The success of the format was shown by the fact that in our lab alone, there were a large proportion of ideas that could very easily reach the prototype stage of development with a little injection of cash and technical know-how.

One of the advantages of the innovation labs format is that they remove the gap between thinking and doing and they encourage the closing of the space between recognising a particular problem and arriving at a potential solution to solve it. Starting not from a big list of things that are wrong with the world, but looking at people and the challenges they face is an excellent way of short-circuiting the ‘someone should do something about this’ response.

One of the interesting aspects of innovation labs is their elective nature. People who get involved with them want to be there and want to take ideas forwards. They are as much about helping people to come together to work on things as they are about the ideas that come out of the process. This presents a stumbling block for people who are used to consultation projects. Innovation labs can and should be inclusive, but they can’t include everyone. They create a situation where people speak for their own ideas, and those ideas make friends with other ideas and as a result those ideas become stronger and find ways of growing and being put into action. Innovation labs, therefore, are focused on making stuff happen rather than establishing an overall consensus of the challenges faced.

Coming as they do from product design, innovation labs are weighted towards coming up with ‘things’ or actual practical projects. The aim of innovation is to find a need, find a solution or solutions then test that solution as quickly as possible before refining it or discarding it. It’s not about identifying the problem alone, it’s about identifying a solution to the problem that will work for the people who experience it. Our lab on Saturday didn’t have any difficulty moving to that method of thinking, but I do wonder how much a challenge this would be for other groups of people? The idea of going ahead and trying to work something out and make it happen, then modifying it as it goes along can seem dangerously risky to people; as does the idea of designing things around people rather than designing them and expecting people to arrange themselves around them.

It’s fascinating how similar the ideas behind innovation labs are to the ways in which the ‘new’ protest movements such as the Occupy movement are run. Both are elective, in that people choose to involve themselves. Both move quickly from idea to working party to action. Both are open to criticisms that the solutions reached by such elective action are not representative in a more traditional democratic sense in that neither seeks to ask ‘everyone’ what they think. Most importantly, both are measurable not by the success or perfection of the process but what comes into being after the process has taken place. They’re both places where the process does not set the end result. The ideas that came from the innovation labs last Saturday were not predefined by the structure set up by the team who ran them. The ideas came from the people who were brought together and supported by the structure of the day.

Looking at the ideas for ‘things that came from the Innovation Labs on last Saturday, I think we’re going to see some interesting results. I met some people with whom I’m really keen to work. I heard some ideas that I’d love to have a hand in making happen and I went away with a head full of ideas for other areas in mental health where we should be doing innovation camps too.

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As we send winter’s edition of One in Four off to the printers, here’s a sneak peak at what you can look forward to…

Cover stories

The kids are alright

Should your mental health complicate your choice to have children?

Complete control?

Writing an advance statement is easier than you think

In the (not so) bleak midwinter?

Presents, parties, resolutions, dark nights: Heaven or hell?

Blog review special

Award-winning blogger Pandora gives a round up of the best mental health blogs

Features

Changing how we see mental health

Catherine Amey explores the issue of stigma

Mind Media Awards 2011

No red carpet, some posh frocks, lots of amazing stories

2011: The year in review

Major mental health stories of the year re-examined

Reviews

Fear of a sad planet

Lars von Trier’s Melancholia reviewed

Mythbuster

If you can’t get help from the NHS there are many community and voluntary organisations that can provide help and support

Plus the latest news!

Does that tickle your fancy? Subscriptions are only £10.00 for a year!

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The below is a speech I gave about young people and mental health.  It talks a lot about my own history and how I came to be where I am now.

“In May 2009 The Sainsbury Centre for Mental Health published a report called ‘Childhood mental health and life chances in post-war Britain’ using data from tracking three large cohorts of people born in the UK in 1946, 1958 and 1970. What they found, amongst other extremely interesting things, was that the best indicator of future mental health difficulties was mental health difficulty as a young person.  These difficulties influenced life chances by impacting on education, which in turn impacted on employment. The authors of the report remark that a large amount of mental ill health among children and young people goes unrecognised and untreated. They also state that only about a quarter of those with a clinically diagnosable disorder are in touch with specialist mental health services.

Despite being fairly ill when I was at school, I didn’t come into contact with mental health services until I was in my late teens and only then meaningfully when I was in my early twenties and at university.  In many ways, I missed out on the opportunity to have help sooner because I was a young person before a lot of the meaningful and important work had been done to really focus on the wellbeing of young people.

I went to a large comprehensive school in the north of England.  I was fairly unremarkable and bookish.  I wasn’t amazingly happy, but didn’t really fall beyond what might have been considered normal.

When we were fifteen, my best friend tried to kill himself.  We’d been away camping, had a brilliant time being drunk, falling in streams and tripping over guy ropes.  I didn’t hear from him for a few weeks then he phoned me to say that he had tried to kill himself and that he was in a young person’s secure unit.  What he complained about most bitterly was that he had to sit and do group therapy with people he had nothing in common with, taking his medication and doing therapeutic activities.  I took him books and tapes.  He hated having all elements of his behaviour pathologised and laughed at the well meaning questions about why the music he liked was ‘so aggressive’.  He dropped out of school completely.  I found him again on friendsreunited a few years ago and he’s a massively successful computer programmer now, so some things do work out okay.

As The Sainsbury research remarks, and I quote “While associations between early mental health problems and later adverse outcomes are strong, they are by no means pre-determined or inevitable. Many individuals escape from risk and some may even flourish in adulthood.”

When I was in the sixth form, things became a little more problematic for me, and looking back, I suppose I was already experiencing what would much later be diagnosed as Bipolar II disorder.

I’m sure that schools now have a far greater idea of useful approaches to take to their young people experiencing mental health difficulties.  When I was at school, a teacher told me that my head of year was going around asking everyone if I was really unwell or if I was putting it on.  He said he’d told the head that ‘I did listen to a lot of Joy Division!’.

Being bookish and rubbish at football had its advantages I suppose in that it meant I was less likely to get into the kinds of trouble that can have really long term consequences.  I think I knew that education was probably my way out of the life that I didn’t feel suited me.

I’m sure that were I to have been at school now, with the increased awareness of the mental health needs of young people that I would have come into contact with services much earlier.

I did pretty well, considering I really wasn’t quite having the best days of my life.  I came out of it all with three A stars at A level and a place to study English and Philosophy at Glasgow University.

And I didn’t go.  I just didn’t say anything about preparing to go to university and then when the day came just didn’t turn up.  I went on the dole instead.

Eventually I became a volunteer and moved away from Newcastle to, ironically, work with people with mental health difficulties.  I went from there to working with people with visual impairments.  In between, my mother died.  I was 19.

By 20, I was so worn out by working, drinking, finding housing, dealing with the aftermath of my mothers death and a relationship that was rapidly going sour that I thought it might be a good idea to take up the offer of university education, if for nothing else than it would represent some peace and quiet, some secure housing and an opportunity to catch my breath after a fairly disordered few years.

Instead what happened was that I became very ill.  I lost it in fact, managing to be at university for about two months over the space of two years, ending up penniless, in debt, nearly homeless and so ill that I couldn’t do anything.  It was only then that I accepted my GPs attempts to refer me to a Community Health Team and only then that I began the process that would eventually see me as the editor of England’s first aspirational lifestyle magazine for people with mental health difficulties.

University, in common with school, is one of the areas that people focus on most when they think about young people’s mental health needs.  I suppose there are two reasons for this.  The first is that it is easy to ‘see’ when young people become ill at university because they are involved in a fixed programme of work in which they either progress or do not progress.  It’s easy to get your head around ‘not well enough to continue his or her studies’.  In a way it’s like a kind of ever rolling cohort study.  It’s possible to collect data from universities about students with disabilities and therefore measure the level of mental ill health experienced by young people while there.  The second and related reason is that the young people at university tend, on average, to be more able to express themselves and in turn have parents who are better able to express themselves and make a noise on their offspring’s behalf.  We ‘see’ young people with mental health difficulties better when they are involved in an organised framework.

University for most is a kind of halfway house between adulthood and childhood, kind of like adult life with training wheels.  Young people who leave school and go straight into work or unemployment do not have anywhere approaching the level of pastoral care commitment and freedom of choice in access of services.  In many ways, it’s their life chances that I worry about more as very often they can, or have, avoided specialist treatment for their difficulties and may be more likely to be stigmatised because of them.

For me, as for other people with mental health difficulties, university presented some particular difficulties.  I wasn’t aware of myself as a person with a disability, as at that time I didn’t have a strong enough diagnosis and mental health difficulties as disabilities didn’t even cross my mind.  Despite being ill, I felt as if I was failing and felt deeply responsible.

Now of course, looking back, I would have sought the support of a disability officer who would have been able to help me make my case for adaptations.  As it was, I felt as if I was on a stay of execution ready to be edged out.

I wasn’t 18 and didn’t have a parents home to go back to, so my life at university was ‘my life’.  If I had dropped out rather than clinging on, I would have been at the mercy of the benefits system and would have been homeless.  I was lucky that this did not happen.

Short of working on an oil rig or joining the army, the traditional model of university is one of the most immersive experiences available.  You are expected to severe all ties with your previous life and launch yourself into a new town, a new pattern of life and to build a whole new set of friends and colleagues all at the same time.  It is easy to forget just how disruptive this experience is, or how much pressure this can put on the individual.

Despite the fact I was older, I was in the position of trying to build a support network of friends at the same time as my condition was making it increasingly difficult to do so.  To assist this I relied on the traditional tools of booze and other things to make this easier, which in turn worsened my condition.  All of this against a ticking clock of needing to be well enough to do the work that I needed to do to stay at university.  It was like a high stakes game that I sadly lost, collapsing in a complete mess.

In common with most young people, the challenges that I faced were not solely mental.  My condition posed me challenges like money, housing, other health problems.  In short, what I needed was support with all of the difficulties in my life, not just my soon-to-be diagnosed mental one.  Like so many people, I’d ended up in a situation where my mental health difficulties compounded my other difficulties and they in turn made my mental health difficulties more difficult to overcome.

There are three main elements that make for a stable life: a regular income, a safe place to live and a supportive network of people.  By going to university, I removed, by my own hand, all of those three elements and it took me a long time to achieve them again.  That’s the challenge with young people and mental health; to ensure that young people have the opportunity to achieve a level of stability that gives them the chance to overcome their mental health challenges and get where they want to be in life.  That’s the real difference between young people’s needs and other groups:  young people might not have had the chance to get things sorted and stable before their mental health difficulties start to make things more complicated.

It’s like a stool.  Three legs, you’re sitting pretty.  Two legs and you can balance pretty well as long as nothing knocks you off balance.  One leg and you’e pretty much just holding on.  No legs and you’re on your arse and everyone else is looking down at you.

When you don’t have any stable things, then you really can have experiences and make decisions that reverberate right through your time as a young person and potential through the rest of your adult life too.

When I finally received a diagnosis, at the age of 22 there was a brief period of relief followed by a much longer period of shock and existential crisis.  On one hand I was relieved to finally have a name to describe the things that I experience, but on the other hand I was suddenly given the task of trying to work out what someone with that label was meant to do with the rest of their lives.  I didn’t really have any positive images of people with mental health difficulties living productive happy lives to draw on, so I was worried that I would forever spend my days in a kind of grey waiting room, eternally sick and suspended.  in some ways I’m glad that I didn’t have that experience to deal with earlier in life.

I’m not sure that having a diagnosis without a store of positive images of people with mental health difficulties as a teenager wouldn’t have made me stop my life in its tracks even sooner.  When people don’t have good positive information and images to draw on, they build their understandings from what they have to hand, namely popular culture.  I had Ian Curtis and Richey James from the Manic Street Preachers.  I’m sure young people today try to make sense of their own mental health difficulties in similar ways.  I hope now, between us, we can continue the work of showing that mental health difficulties are just a normal part of life and that it’s not just doomed rock stars but mothers, bank managers, nurses, hair dressers, footballers and even magazine editors that have them too.

I think things have begun to change for young people with mental health difficulties.  There is so much more awareness now, admittedly some of it less helpful and well meaning than it could be.  We have to get away from the narratives of tragedy of wasted potential on one hand and containment of problems on the other.  People have mental health difficulties full stop.  What they are is challenges, and they need help to overcome them.  And that’s where we come in.

When I talk to young people, they agree with Kat Cormack, one of Young Minds VIKs that young people aged 16 25 need specific services geared to their needs.

And to that I’d add that one perennial thread that runs through all young people talking about mental health services is that they’d like better information about exactly what they can do if they’re having difficulties and what services such as CAMHS can offer them.

If that information had been around when I was a teenager, it would have been me that took myself to services, because I knew better than most that something wasn’t going as well as it could have been.

Thanks!”

Speech given to the Mental Health Today Exhibition seminar ‘Younger people and mental health’ Business Design Centre, London 08 December 2009

Mark Brown is the editor of One in Four magazine.  He’s not feeling that young anymore .

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