Coming up in the Spring 2012 issue of One in Four

The sunshine is nearly here, the plants are budding (again!) and it’s time for Spring 2012’s issue of One in Four.

The new issue has loads of real life stories, advice and new ideas for looking after your mental health and getting on with life despite any mental health difficulties you might have.

The new issue has advice and experiences from people who are working and managing their mental health, top tips for getting sorted this spring, personal experience of having a mental health difficulty when in prison, personal experiences of bringing up children while experiencing mental health difficulty, a run down of what the major mental health actually do and don’t do, mental health in rural life, debate about technology and mental health and debate about whether Borderline Personality disorder is a useful diagnosis and the usual mythbusting, reviews and news.

The article ‘In bad nick?’ about having a mental health difficulty while in prison is an eye opener and makes points from a first person perspective that you won’t have seen elsewhere.

As ever, we think it’s brilliant, but what do you think? Why not pamper yourself and spend £10.00 on a year subscription?

Where are the talking heads?

I was reading this interesting piece of research today about the bias in reporting of mental health stories.

The headline conclusion is that there is a difference between what stories about mental health New Scientist magazine chooses to cover and what stories the BBC chooses to cover.

The research was conducted by George Szmukler at the Institute of Psychiatry and his colleagues. It focused on coverage of mental disorders research on the BBC news website from 1999 to 2008, and in New Scientist magazine news and features from Aug 2008 to April 2010. This led to the identification of 1015 relevant stories on the BBC (102 per year) and 133 stories from New Scientist (76 per year).

The researchers concluded that both tended to focus more on medicalised discourses around mental health with seventy-five per cent of the BBC’s coverage on biological research; New Scientist showed a similar trend. There was less discussion of psychological approaches.

What really interested me were their findings about commentators. They found that while most BBC stories included quotes from commentators intended to provide some context, including from 973 named individual: “There was a bias towards medical commentary. The six most frequently quoted commentators included three from the Alzheimer’s Society, two from the Alzheimer’s Research Trust and one from SANE.”

In short, most stories about research into mental disorders written up for BBC online were about biology and most had commentary from a medical perspective; so in those stories we had doctors mostly talking about brains.

Where are we in this?

While this research covered only stories about medical research into mental disorders, it set me thinking about how mental health related stories are represented in the media. The question it posed for me was: ‘Why don’t we get more people who experience mental health difficulties as commentators in news media?’

We’re all familiar with the ways that television, radio and print represent news. There are ‘on the spot’ news stories where journalists themselves are present as something unfolds. These could be called ‘went there, found something out’ stories. These will usually contain input from people ‘at the scene’ who contribute what they saw or experienced.

The problem is that a lot of things that happen in the world don’t happen in ‘on the spot’ ways. It’s quite easy to report a building on fire, but it’s a bit more difficult to report the reasons why the building is on fire if it’s related to the choice of building materials or a series of pieces of legislation. Print media is much better suited to covering complicated stories that unfold over time and require context and knowledge for you to make sense of them.

Television news does something that you might call ‘pseudo on the spot’ reporting, where reporters go to where something is or has happened and broadcast as if the story is unfolding, despite the fact that the real action has either already happened or is actually happening somewhere else. Think of freezing cold reporters standing outside of government buildings talking about something that happened there earlier that day.

As not that much really happens in ‘real time’ news reporting of television and radio relies far more ‘talking heads’ to create stories. You’ll get your reporter standing in the drizzle somewhere, but you’ll also get a series of spokespeople, talking heads, pundits, experts, correspondents or sundry other figures who’ll be used to add further information to the story. Radio works in a similar way.

Often there’ll be a space for a spokesperson to make a response. Spokespeople are always representing the interests of a particular organisation, body or group.

Sometimes, there’ll be a contribution from someone affected by the subject of the news story. If it’s a story about mental health this is where you’ll see a contribution, if you’re lucky, from a person who experiences mental health difficulties or someone who knows one.

What happens a lot is the use of people talking to provide different points of view on a story or to add additional information or points of interest. They are used to try to work out what a story actually means. The classic format for this is ‘here’s a person who agrees with what is happening in this news story, here’s a person who disagrees and it’s over to our expert for more details’.

Often these people are not directly concerned with the events that make up the news story but people who know something about it, or have something to say about it, and, if you’re lucky, people who both know about it and have something to say about it. The format can set different views against each other or bring differing points of view to addressing a particular issue. More often than not, the format tends to be based on speculation (“what effect do you think this story will have?”) or statement of position (“where do you stand on this?”). Sometimes it’s not clear whether a given contributor is occupying one or the other of these positions.

What I wondered is: Why aren’t there more mental health talking heads? Or to put it another way; why aren’t more people with mental health difficulties asked what stories about mental health mean?

Who is asked to speak and why?

It would seem that we will get a medical view in the role of expert, often a charity view from the point of view of spokesperson and a person with mental health difficulties in the role of personal experience (if there’s space for that) but we’ll very rarely, if ever, get a person with mental health difficulties in the role of commentator or person with an interesting point of view on the issues involved in a story or the ability to explain what a story means.

I was recently at #transcamp, organised by TransMediaWatch, a day devoted to trying to find ways to make media coverage of trans people and trans issues better and more accurate. A lot of the discussion revolved around the fact that there were very few accurate portrayals of trans people in the media. One of the things that was recognised was there wasn’t many trans people who could communicate the experiences of the trans community in a direct and engaging manner. The subtext to this was that somehow trans people needed to find ways to transcend the stereotypical ways in which trans issues were represented.

Trans people are often represented in ways that fit existing media narratives. In other words the media finds trans people to be trans in the way that the media expects trans people to be. Trans is treated as an issue (with for and against) as much as it is represented as an experience. The people were enlisted by the media to tell the story that the media had already decided it was telling. One of the main themes that came out of the day was that trans people need to find ways of telling stories in mainstream media that manage to ‘jump the rails’ of established stories, so shaking off the position that the story assigns to them.

In that discussion, it occurred to me that the issue of ‘speaking for’ or ‘speaking on behalf of’ was not a simple one. It set me in mind of a segment from mid-nineties satirical news masterpiece The Day Today where the news anchor character played by Chris Morris was interviewing a black man subtitled as ‘speaking for every black person’.

When you get a spokesperson it’s acknowledged that they represent a partial point of view. When you get someone with direct experience they are often somehow seen to embody all possible points of view or all people affected, like speaking for every black person.

When we were discussing this at #transcamp, I raised the case of the Tax Payer Alliance. They are regularly wheeled into news coverage to make a statement about the use of ‘tax payer’s money’, usually in opposition to someone suggesting how some of it should be spent. You’ll most often see them as presenting the ‘balancing’ point of view in a segment discussing changes to public spending. The Tax Payers Alliance is on the news because it represents a very clear set of ideas in a clear way representing a clear interest group. In other words people know what they’re trying to make happen and where they fit in to the story. They provide the taking heads that are needed by the people making news coverage.

This set me wondering; why isn’t there a similar set of people providing trans opinion or indeed mental health opinion?

Where are the mental health talking heads?

Interestingly, I think that trans people in the UK are closer to carving out that space than people with mental health difficulties in the UK.

I’d hazard to guess (and am very open to being corrected) it’s because trans people in the UK don’t really have the same history of others speaking for them and are not also seen as a ‘social challenge’ in the same way that people with mental health difficulties are.

They also aren’t seen as part of an amorphous group, because they have managed through the work of previous campaigners to avoid being pigeon-holed, but also because trans people aren’t seen as ‘afflicted’ in the same way that people with mental health difficulties are, despite experiencing high levels of very real discrimination and prejudice. As such, they are seen as a minority carving a way through life, rather than a collection of symptoms who may potentially one day be ‘cured’. They are seen as the people who have the answers about what it means to be trans. With mental health it sometimes feels like the instinct is to turn to everyone but people with mental health difficulties to explain what an event that affects us actually means.

As the research outlined above suggests, mental health is still seen as primarily a medical issue rather than as a disability. To put it another way, it is seen as an abstract experience of ill health rather than something that people live with over a period of time. Eventually, the research model suggests, mental health difficulty will be eradicated like rickets or TB. Mental health difficulty is seen as something that can be solved, and as such, does not represent something that is weaved through all of the elements of the life of the individual that experiences it.

Both the major charities and the medical establish still continue to present mental health difficulty through the prism of ‘problem/solution’ rather than through the prism of lived experience. This is in contrast to the ways in which people with other disabilities have developed the social model of disability as way of building a story about disability that does not rely on society doing something for people with disabilities but demands that society gets out of the way and stops making disability the issue rather than recognising it is society that disables by the way it is put together in favour of those without disabilities.

There is still an over-riding bias toward seeing people with mental health difficulties as a group that others do good for without seeing us a discrete group in society who may have opinions and ideas of our own.

Debate is still couched in terms of ‘we need to do something about or on behalf of people with mental health difficulties’. This is part of the reason why celebrity spokespeople remain as ‘taking heads by proxy’, in theory members of the group being spoken about but in actuality still occupying the paternal role of requesting that someone do something on behalf of the those poor unfortunates.

In short, we are not seen as people who may have insight or ideas into our position in society because we are not recognised as an actual minority group with specific challenges.

Imagine, if you will, a spokesperson appearing on mainstream news coverage and beginning a sentence with ‘People with mental health difficulties in this country feel that…’ or ‘The effect of this legislation on people with mental health difficulties will be…’

Then imagine BBC Question Time featuring a person representing the ideas of people with mental health difficulties as a specific group in society in the way that, say, Owen Jones represents the ideas of a specific strand of socialist thought or Melanie Philips represents a certain strain of centre right opinion.

It could be concluded that for us as people with mental health difficulties we have not yet passed the point where we are ‘allowed’ by news media to have ideas about our condition and our place in life. We can contribute information about our experience to provide context and colour, but, as yet, we don’t have a strong enough voice to be allowed to make arguments about what it actually means to us as a group of people.

So, what’re we going to do about it?

For an idea of what disabled talking heads might look like, have a look at this archive footage from 1990 (hat tip to @e_lisney on twitter)


Mark Brown is the editor of One in Four Magazine

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Out-takes from a thinkpiece 5: The role of fixers in making things happen

The following is an out-take from our pamphlet ‘Better mental health in a bigger society? (published by Mental Health providers Forum in December 2011 and available for download for free here).  It recognises and celebrates the role of fixers (or connectors) as the people who get things to happen in mental health.

Traditionally, the NHS has sat as a structure by itself. It has been a closed system only making contact with the community either through the provision of services or when it has invited involvement.

It has seemed to many that you were either working within the NHS or outside of it, either a patient or a professional.

Increasingly, as this paper discusses, the lines between these categories are becoming blurred. People may be both patients and professionals, people may be working in the community but employed by the NHS or local authorities. Projects may be collaborations between different services. Individuals may spend some of their time working in peer services, some of their time working in more traditional roles. Solutions to problems may begin from a medical analysis of prevention, recovery or wellbeing but end up being enacted by a local church, a branch of an employment advisor, a small community group or a social enterprise.

The landscape is not state services, surrounded by clusters of everything else. The landscape is already a complex network of different forms of organisations, services and groups all working in some way toward the better overall mental wellbeing of the communities.

What becomes clear is that for this mixture of different organisations to work together in a way that generates the greatest possible outcomes for all parties in a community, there must be something that stitches them together.

From the outside, the NHS can seem opaque and impossible to engage with. This is not just a complaint of people who use NHS services, though this is often levelled, but also a complaint of those wishing to engage with the NHS to make things happen. This may also be a complaint of those that are currently working within the NHS.

It can be difficult for anyone to find ways to get to the right person inside a complex organisation whilst on the outside of that complex organisation. It can be difficult for people within a complex organisation to get to the right person.

For many of the suggestions in this paper to take place, it is necessary to recognise that often it is people who make things happen as much as structures and procedures.

At present, too many good ideas are tied into inward looking projects and services, with huge amounts of knowledge, experience and expertise bundled up in people occupying particular roles or positions that do not allow them to make those ideas happen or to assist others in doing so.

In many areas, the difference between an effective and fertile relationship between these different groups, organisations and services and a dysfunctional or unproductive one is whether there are people in any of those organisations who make it their business to meet, discuss, support and network with others in the same area, regardless of what service they come from.

These are the people we refer to as fixers. They are the people that have both skills and experience themselves which they use to make change happen, but also the skill of seeing how other people might come together in new ways to make things happen. Regardless of where they are based, fixers move between different forms of organisation and different groups of people finding ways of taking positive change forward.

Because fixers feel confident in working with all forms of organisation, they provide valuable insight for all as to how they might work better together. They can smooth waters between organisations that have been traditionally antagonistic, they can transfer knowledge from one silo to another, they can provide the overview necessary of the overall picture while providing specific information to all parties in that picture.

Fixers can be catalysts around which new projects begin, or the glue that helps bond new and old together.

The defining characteristic of a fixer is that the focus upon making sure that things happen for the overall good rather than focusing on the interests of one particular service or group.

EXAMPLE: In some areas, such as the North East, a number of individuals have arisen who fulfil the role of fixers

In the North East a range of organisations and individuals have responded to the need for joined-up action between and understanding of roles of state and voluntary sector agencies.

At a regional level, Mental Health North East (MHNE) is a small umbrella organisation that was formed in 2005 to use the combined voice of voluntary sector organisations providing mental health services to represent the sector to government agencies.

MHNE works with locally based networks and forums to ensure that voluntary sector providers, including smaller user led organisations are not ignored by commissioners and policy makers.

At a local level, Newcastle-based Launchpad is an organisation that offers the chance for people who use services to have their voice by the people who run those services. An essential part of fulfilling that role is for Launchpad’s team to understand the landscape in which services are delivered.

That means attending all relevant meetings and committees with the local authority, local NHS agencies – knowing who is responsible for deciding what and on what basis – and creating opportunities for service users to make their voices heard to the right people in a way that is most likely to effect positive change.

As Launchpad say:

“People who use services are ‘experts by experience’, and our knowledge and insight are invaluable for improving the mental health system. We try to put across service user views to bodies as diverse as the Strategic Health Authority, the Primary Care Trust, the Northumberland, Tyne and Wear NHS Trust (NTW), the city council, social services, the police, voluntary organisations, charities, and MPs, to name just a few. There are as many service user points of view as there are service users, so we convey as wide a range of opinions and outlooks as possible.”

The work of Delivering Race Equality in Mental Health’s Community Development Workers is a good case study of the attempt to create fixers to improve outcomes in a particular area.

However a fixer arrives at their role, one of the primary things that they will make clear is that relationships and strategies that exist on paper are no substitute for the real-life problem solving that happens on the ground.

Fixers know that everything that should fit together does not always do so, because they make it their business to see how things a playing out in the real world. Fixers are also good at understanding and explaining how complex systems work to those outside of them.

Fixers also know that relationships and projects are made by people, not solely by policy.

Without fixers, the radical potential for new ways of working and new outcomes for people with mental health difficulties run the risk of becoming empty, instrumental exercises where things are put into action but people are left out.


  • The NHS and local authorities must accept that increasingly the key to meeting desired outcomes in mental health will be based on networks of individuals and organisations, not hierarchies. NHS and local authority services will be some amongst many and will need to ‘open up’ to outsider influence and contact.
  • Fixers link together organisations, ideas, individuals and events. They play an essential role in making the higgledy-piggledy real world of mental health services work. The NHS and local authorities need to recognise where fixers are evolving and support them.
  • The NHS and local authorities should engage with the Community Organisers currently being trained as part of the government’s Big Society programme.
  • The NHS and local authorities should review the lessons learned from the Delivering Race Equality in Mental Health Community Development Worker programme, as it represents a possible model for artificially creating fixers.

Our project ‘The New Mental Health’ is currently looking for funding from people like you. You can pledge as little as you like to help us to bring together a book on how organisations are changing the lives of people with mental health difficulties in new ways.

Watch the video here to see if you can help.

Out-takes from a thinkpiece 4: Have traditional services kept pace with the aspirations of people with mental health difficulties?

The following is an out-take from our pamphlet ‘Better mental health in a bigger society? (published by Mental Health providers Forum in December 2011 and available for download for free here).  It wonders whether traditional models of service design have kept pace with the aspirations of people with mental health difficulties.

It is a matter of urgency that NHS and local authority services consider their response to personalisation, recovery and wellbeing. Continuing with older notions of service delivery will not generate the structures needed to make any of these developments a success. Failure to act has the potential to actually increase the demand on service rather than reduce it.

Personalisation, recovery and wellbeing can only be delivered properly where the NHS, local authorities and the voluntary and community sector work effectively together. To fail to do so will erode the radical potential of these concepts for transformation of lives, with private sector providers stepping into the vacuum created by the loss of traditionally provided services.

In times where there has been ‘enough’ funding to go around, it has been possible for voluntary and community organisations to develop in parallel with NHS and local authority organisations with minimal interaction.

It has, at best in the past, often been a distant and wary relationship, fraught on both sides with misunderstanding and misapprehension.

Where these parallel threads have met it has tended to be either when state services wish to solicit help in carrying out consultation or engagement or when the voluntary or community sector wished to access funds or compete for contracts. It has tended to be a relationship where the fact that different groups and services are actually providing services and support to the same communities of people has been obscured. Organisations, whether state, voluntary or community have tended to bunker down and concentrate on doing the things that they do, often in the ways that they have always done them. This is the ‘we don’t get involved, we just get on with doing what we do best’ approach.

While it is admirable to remain focused on meeting your responsibilities, it is not an approach well suited to the current economic or political situation.

In the context of reduced overall spending, the NHS and local authorities must be able to work strategically with local organisations to make sure that aims and aspirations are met, at a time where demand for mental health support and services will rise.

As we hope to show, the needs and wishes of people with mental health difficulties are changing more quickly than a rigid focus on service delivery can accommodate. We are both trying to raise the aspirations of people with mental health difficulties to develop ownership of their recovery, putting them in the ‘driving seat’ of services and support defining their own goals and outcomes while at the same time having difficulty in responding to those aspirations and demands within existing inflexible methods of service delivery.

Common definitions of wellbeing are based on two basic attributes: Hope and agency. For individuals to possess a sense of wellbeing they must both possess a hope that things can and will be all right in future and they must also feel the agency to feel that they themselves can take actions to influence the course of events that will help them to be so. This is also one of the fundamentals of recovery.

At present, state services have often failed to help individuals to achieve this.

The causes of this failure have often been complicated and there is no one uniform reason why some people involved with services to help and support them to recover from mental ill health and maintain mental wellbeing have become disillusioned.

Commonly, people complain of feeling a lack of ability to influence the treatment they receive, a lack of choice in service they receive for support and an overall feeling of getting to where they want to despite the support that they receive rather than because of it.

It becomes clear that, for some, the experience of interacting with services that are inflexible and over which they can exercise little control in fact contributes to the overall sense of disempowerment they experience as part of recovery from a period of mental ill health.

There has been a pervasive, and to many frustrating, idea that the role of finding new and innovative ways of solving problems and generating opportunities for people with mental health difficulties somehow lies outside of the remit of people doing ‘normal’ jobs working in existing services and is the responsibility of people specially employed to do so.

In a sense, what service users, community groups, other providers of services and even colleagues from within the public sector hear is ’It’s not my job to make those kinds of things happen. I have lots of responsibilities and obligations and what you’re asking is beyond what I am charged to do’. Taken at a service-wide level, this creates a situation where the majority of people interacting with each other in the process of generating mental health and wellbeing outcomes, on either side of the service user / service provider divide, are telling each other that it isn’t their job to help services meet the needs and wishes of people that use them.

In the voluntary and community sector, where smaller organisations can be more flexible, a similar refrain is more likely to be related to funds and resources: ‘I hear what you’re saying, but we’re overstretched as it is. Maybe we can do something about this if we can secure some more funding. As it is, our funding and contracts commit us to doing these things, so we have to make sure that we do them.’

In mental health we have a situation where we are committed to developing hope and personal agency and are required by economic necessity to find new ways of doing the things we do in mental health.

Too often we have a situation where the development of personal aspiration and recovery misses making contact with the development of services and support.

At present, lots of work goes into building from both sides of the river but too often the two sides don’t come together to bridge the gap. Sometimes the just miss each other slightly and can be fixed, but for others the direction of travel deviates so severely that there is no hope that they could ever meet.

At present what people with mental health difficulties might want from services and what services can deliver often fails to meet and bridge the gap between the two.

Our project ‘The New Mental Health’ is currently looking for funding from people like you. You can pledge as little as you like to help us to bring together a book on how organisations are changing the lives of people with mental health difficulties in new ways.

Watch the video here to see if you can help.

Out-takes from a thinkpiece 3: An (over-optimistic?) introduction to mental health and Big Society

The following is an out-take from our pamphlet ‘Better mental health in a bigger society? (published by Mental Health providers Forum in December 2011 and available for download for free here).  Written in late February 2011, it was the original introduction to ‘Better mental health…’.  It stresses the opportunities for new kinds of project put together from new mixes of people and the opportunities that Big Society could afford for autonomous action by people with mental health difficulties.

At present Big Society is a contested idea, but one to which the current government is committed.

The Big Society analysis grows from recognition of a number of significant challenges faced by the agencies and organisations responsible for the delivery of public services.

Whether we agree either with the political beliefs behind these ideas or with the overall conclusions that this analysis arrives at, it is inescapable that some of this thinking creates an opportunity for taking forward many ideas within the mental health world where people with mental health difficulties and professionals are in agreement.  It also provides a wider policy context within which these ideas can be viewed and understood.

It is this wider context that allows us to step outside of seeing any of the ideas discussed in this paper as simply mental health ideas and allows us to draw from experience, learning and expertise from across sectors and groups in the community.

It helps us to see that while mental health treatment is necessarily specialist, the people whom it treats are part of communities and that the challenges they face are not only medical but encompass all of the stuff of life.

This Big Society moment gives us opportunity to look at new ways of making things happen that do not rely on old, often exhausted, ideas of service delivery.

One of the most radical possibilities of Big Society is the breaking down of barriers and divisions between different types of people working towards a common social good.  Rather than the answer being state services, charities and community groups working in their own separate spheres only coming together when each needs something from the other, Big Society suggests ways all of these different forms of organisation can work together as peers, aware of the different role each has, but finding exciting new ways of bringing those roles together to best met the needs of those that need them.

Despite any political reservations that individuals and organisations might hold, the broad scope of the Big Society idea encompasses many of the ideas that both people with mental health difficulties and those who provided their services have been pushing forwards for over a decade.

While there are a range of views on the rights and wrongs of the steps that the current government is taking, what is clear is that Big Society is being implemented during a period of deficit reduction and a difficult contraction of public sector spending.

For the National Health Service the Big Society coincides with plans of significant NHS reorganisation outlined in the Health and Social Care Bill 2011, the new mental health strategy for England No Health without Mental Health, changed priorities in public health, changes to local council responsibilities and budgets and alterations to the benefits system.

In many of these proposed changes of policy, resource allocation and direction, the path leads back to Big Society, as a means of making sure that the needs and aspirations of people are met.

This discussion piece seeks to explore some of the ideas of Big Society and the way in which they represent new suggestions for meeting some of the aspirations and challenges held by mental health services and the people that use them.

In many cases, Big Society presents a new way of approaching tasks, obligations, aspirations and goals that mental health services are already exploring or delivering. It also suggests new avenues that the NHS can begin to explore and presents an opportunity to remove some of the negative systemic factors which have plagued the development of true community mental health services and which have frustrated both professionals and service users alike.

It suggests a new settlement between individuals and the services that they use, and a new landscape where the NHS is one provider of services amongst many.

As many critics rightly note, the Big Society should not give license to ignore the question of funding for mental health related work but, as this paper shows, does suggest some new possibilities for making mental health funding work harder and help develop lasting structures that will support future work.

It also presents possibilities for advances in the way that people who are experiencing mental health difficulty are supported and, most excitingly, suggests pathways towards people with mental health difficulties escaping from the position of being passive recipients of services and becoming true partners in defining the direction of the support they receive.

Seeing the opportunity to support and work with small, community based projects and organisations creates an environment that brings together a number of the positive, forward looking streams of thinking within mental health.

Peer led services – Small community based organisations and projects are far more likely to involve self-determination on the part of those that use and deliver them. The flexibility of these services allows for the incorporation of individuals with varying levels of disability and experience.

Services responsive to local need – With the correct support, local people with mental health difficulties can find ways of meeting their own non-treatment needs

Personalisation – Small community based organisations and projects can serve a variety of roles:

1.they can be the providers of services purchased by those with personal care budgets
2.they can be the organisations that act as brokers and fixers for personal care purchasers
3.They can be the result of personal care purchasers own decisions

Meeting needs that NHS services cannot – The NHS is structured to be very good at some things. Where it is less good at things is as much a result of structure as it is of failure of intention or policy. This is not a criticism of the NHS. Conceptions of mental health and wellbeing have evolved greatly since the creation of the NHS, as have the expectations and aspirations of those experiencing mental health difficulty. In some senses, there is an inherent conflict for the NHS between providing specialised care and treatment in mental health and taking a holistic approach to mental wellbeing. Smaller, more flexible, non-medical projects and organisations can meet these needs where the NHS cannot.

Minimising the cost of innovation – Innovation is an expensive business, but vital. Within large organisations innovation is expensive. Small community based organisations and projects are less likely to carry expensive overheads and have more flexibility in how they resource projects. They do not carry the weight of the NHS on their backs.

Co-production – This is an obvious area where Big Society ideas overlap with the existing direction of travel in mental health.

Big Society ideas give us an opportunity to make people with mental health difficulties the centre of the mental health world, rather than passive recipients of services provided on their behalf.

This paper seeks to pose the questions:

How can Big Society ideas help advance existing desired outcomes in mental health?


How can Big Society ideas help people with mental health difficulties do the things that they wish to do?

Our project ‘The New Mental Health’ is currently looking for funding from people like you. You can pledge as little as you like to help us to bring together a book on how organisations are changing the lives of people with mental health difficulties in new ways.

Watch the video here to see if you can help.

Out-takes from a thinkpiece 2: Big Society meets personalisation, recovery and wellbeing

The following is an out-take from our pamphlet ‘Better mental health in a bigger society? (published by Mental Health providers Forum in December 2011 and available for download for free here).  It examines the overlap between Big Society ideas and recovery, personalisation and wellbeing in mental health.

Big Society provides new ways of looking at some of the most exciting and challenging changes faced by services for people with mental health difficulties. Personalisation, recovery and wellbeing represent an existing movement to bring the individual into the process of deciding the direction and type of care, treatment and support that they need while extending the frame of reference for mental health services beyond traditional boundaries.

All three are areas where the historic division between services, communities and individuals creates barriers to successful outcomes.

Personalisation of services is the direction that health and social care services were travelling in prior to the arrival of Big Society as an idea, but which resonates well with the Big Society concept of empowerment of individuals and removal of monolithic provision.

Within mental health, many service users, professionals and organisations have already begun the process of shifting from ‘one size fits all provision’ to the principles of personalisation of services.

At present, services are commissioned by one body, purchased by another and then presented to the actual person who will use them.


Personalisation, as a mechanism of direct choice, will completely change the relationship between people with mental health difficulties and the services that they use. It will also create situations where the role of the professionals not directly providing treatment will shift to guiding and supporting individuals to meet their needs in ways that those individuals feel appropriate.

Personal budgets will mean that individuals will be purchasers of services themselves directly through personal budgets. While there are ongoing national pilots of personal budgets within the NHS, some of which involve people with mental health difficulty, the major short-term impact of personal budgets is in the field of social care.

As of April 2011, anyone assessed by their local authority as having social care needs should, in theory, be offered a personal budget to spend on services or support to meet those needs.

Local authorities are at different stages in terms of providing this facility for people with mental health difficulties who have identified social care needs. There is currently a significant diversity of approaches to determining who is entitled to a personal budget, how the level of the personal budgets is calculated, what the personal budget can be spent on and how people with mental health difficulties can and should be supported in spending their personal budget.

Many local authorities are not yet in a position to explain the opportunities offered by personal budgets clearly to people with mental health difficulties, others plan to begin to shift social care provision to an almost entirely personalized model in the coming months.

Greater personalisation, both in social care provision and ultimately within the NHS, potentially offers significant opportunities:

  1. For user-led organizations to provide services that can be purchased through personal budgets
  2. For user-led organizations to provide services to support people with mental health difficulties in spending their personal budgets to meet their needs
  3. For groups of people with mental health difficulties to pool some of their personal budgets to pay for services (or other support) that meet their needs

Point 1 is both one of the great opportunities for personalisation (and The Big Society) but has the potential to be one of the most significant missed opportunities.

In the field of social care, work by local authorities to prepare small user-led organizations for the coming of personalisation has been distinctly patchy.

Probably due to the fact that local authorities themselves are – in many cases – unsure about the practicalities of providing personal budgets, there has, with honourable exceptions, been a severe lack of practical support available for groups who have been providing services funded by block grants but will in future need to sell their services to individual service users spending personal budgets.

The Big Society ideal for personal budgets is that service users end up with a wide choice of options for meeting their needs including sustainable service provided by user-led organisations and opportunities to use personal budgets to do their own thing outside a structured framework of service provision.

As personalization is rolled out in social care and personal budgets increasingly become available to NHS service users, the NHS has a key role in supporting service user-led organisations to enable them to make this happen.

EXAMPLE: In Leeds, Keeping House, a Leeds City Council funded initiative to encourage the development of services that help people to live independently, has launched Ideas That Change Lives – a scheme to invest in and support the development of new socially enterprising ideas to support independent living.

The scheme will invest £10,000 in the six best ideas generating by the local community and provide a package of business support to enable the people with the ideas to take their projects forward.

The scheme also offers smaller ‘Kick-Start’ grants of up to £2000 to help individuals and organisations to turn ‘ideas which have potential’ into ideas that gain a greater level of support.

Those developing ideas for investment are encouraged to attend an Investment Application Planning Session and use a specially developed Business Plan Template to submit their application.

Applicants are encouraged to call and speak directly to the team managing the programme. There is an emphasis both on the importance of developing sustainable and well-planned social business ideas, and also on people who have ideas for services but don’t feel that they’re business experts getting the support they need to make their ideas a reality.

Recovery and Wellbeing

Within mental health personalisation has crossed over with the development of two important additional processes of rethinking the manner in which individuals are supported to reach their potential: Recovery and Wellbeing

Recovery puts the individual at the heart of defining what the outcomes for her or his treatment should be. It takes as its very principle the proposition that services should not try to judge where an individual should end up, but support them in their journey toward the point that they define, which may encompass far more than medical measures of freedom from symptoms. In actuality, recovery represents a way of acknowledging that the needs of individuals with mental health difficulties may change over time and fluctuate depending both on conditions but also life situations.

The gradual move to a wellbeing-focused approach represents a fundamental reconfiguration of the way in which the NHS regards its role in the lives of the people who use it. Rather than asking the question ‘what do we do for people who are ill?’ it poses the question ‘what do people need to be well?

In a mental health context, this presents a number of challenges and opportunities.

The first is the challenge already recognised by No Health without Mental Health and its emphasis on early intervention. This takes a reorientation of services to recognising what needs people have and meeting them as quickly and efficiently as is possible.The second is a wellbeing approach extends the terms of engagement in mental health far beyond the walls of the consulting room, GPs surgery or ward.

All together, personalisation, recovery and wellbeing can only work in a system where flexibility exists and where people with mental health difficulties determine their own outcomes and goals.

Our project ‘The New Mental Health’ is currently looking for funding from people like you. You can pledge as little as you like to help us to bring together a book on how organisations are changing the lives of people with mental health difficulties in new ways.

Watch the video here to see if you can help.

Out-takes from a thinkpiece 1: Self help vs. Service delivery

The following is an out-take from our pamphlet ‘Better mental health in a bigger society? (published by Mental Health providers Forum in December 2011 and available for download for free here) This unused section looks at where people with mental health difficulties in the community fit into the mental health world.

The NHS provides medical services well, and most people wish them to continue to do so. The idea of medical services provided by non-medical staff is not what this paper is about.

There is great potential for people with mental health difficulties working with existing NHS structures to develop new and innovative ways of supporting others with mental health difficulties. There has traditionally been confusion within the NHS and within the wider community of people with mental health difficulties and those that support them as to how to classify projects, groups and organisations who deliver mental health related services which are not, in themselves, medical. This has led to a prickly relationship between the NHS and other community based organisations.

This in part has arisen from the idea that mental health is simply a medical issue, rather than being a medical issue with significant social aspects. Coming from an approach schooled in medical thinking, organisations and groups that have come together in ways that arise from the experiences of people with mental health difficulties and those that know them can seem chaotic, fragile and to lack a strategic focus. This is the reality of groups that come together voluntarily and which reflect the on the ground responsiveness and knowledge of life with mental health difficulties that services can sometimes lack.

Organisations and groups closer to the ground have both numerous advantages and significant disadvantages when compared to services developed within the NHS. Such groups often exist to meet needs defined by themselves, their members or users. They are often extremely good at identifying gaps in provision or support and filling those gaps. This can be defined as the self-help aspect of the Big Society where people come together to find solutions to their own problems. It is important that groups like these are nurtured and supported, and that mental health services endorse and enable such groups. It is also important that these groups should not be considered substitutes for services, or treated as extensions of services.

A significant area of difficulty lies in the funding, resourcing and supporting of groups and organisations led by people with mental health difficulties. These groups may be in a position to be contracted to deliver services, but need additional support and expertise to do so effectively – seeing them solely as additional means of service delivery can neuter their potential to deliver real innovation and change. Often the process of securing service delivery contacts lies beyond the reach of groups that have come together to meet specific community needs. Reconfiguring these groups or organisations as service deliverers often removes their potential to remain flexible and to innovate.

The objective for all NHS services must be to create the optimum situation for these organisations to grow and develop, as it will be these groups that increasingly will be the conduit between the NHS and the community, and will enable the NHS to meet goals within mental health that otherwise would be difficult to achieve. Organisations, projects and individuals need to be supported from within the NHS to make a difference both within its services and without. This will involve both bringing such self generated projects, groups and organisations into the NHS as partners while also ‘opening up’ the NHS to be able to utilise and respond to these self determined groups as they arise.

The question all NHS staff need to be asking is ‘If someone did have a great idea, would they be able to get to me to tell me, would I be in a position to recognise it and could I help it to happen?’

The question that people with mental health difficulties need to be asking is ‘If the NHS was to support me to find ways of meeting my own needs, what would that support look like and what would I expect?’

Our project ‘The New Mental Health’ is currently looking for funding from people like you. You can pledge as little as you like to help us to bring together a book on how organisations are changing the lives of people with mental health difficulties in new ways.

Watch the video here to see if you can help.


So that was christmas, and what have we done?

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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On spending a Saturday innovating

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.

Would you like to know what’s in winter’s One in Four?

Cover of One in Four winter 2011As 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


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


Fear of a sad planet

Lars von Trier’s Melancholia reviewed


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!

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