New publication asks ‘how do we make sure that a Big Society doesn’t fail people with mental health difficulties?


Seeing people with mental health difficulties as people who can find solutions to their own challenges and ways of achieving their aspirations means taking a step on from seeing mental health simply as a range of conditions requiring care, support or treatment.”

This is a quote from ‘Better Mental Health in a Bigger Society?’, a new thinkpiece written by the people who bring you One in Four that examines the question: How will a Big Society approach affect the lives of people with mental health?

The thinkpiece,  to be published on December 5th 2011 by Mental Health Providers Forum, discovers surprising overlaps between Big Society ideas and changes that many people with mental health difficulties have long hoped for but set within a climate where pressures on public finances risk destroying the potential for community innovation.

It suggests ways in which the NHS, local authorities and new health and wellbeing boards can support the development of a strong and diverse mental health landscape. This means supporting community groups to enable them to provide real choice and opportunities for people with mental health difficulties.

As an alternative to a Big Society vision based on altruistic volunteering, the thinkpiece explores ideas such as co-production, peer services, personalisation, user-led organisations, and other community-based activities that put people with mental health difficulties at the heart of their own recovery.

‘Better Mental Health in a Bigger Society?’ challenges the tendency for thinking about mental health to focus solely on discussions of medical services. It provides examples of innovative mental health projects delivering the non-medical support that people need to stay well – many of which will be under threat from lack of funding as local authorities and the NHS retreat ‘behind the front line’ to concentrate on ‘core services’.

Mark Brown co-author of the thinkpiece and a person with mental heath difficulties himself says: “We stand a point where there’s a great opportunity for positive change for people with mental health difficulties but there’s a real danger that innovation and change will be strangled at birth by inability to recognise that new situations require new thinking. We’re looking for a new settlement between NHS and local authorities and the communities of which they are part. If we are to have a Big Society, then change from the bottom up must not be an empty promise.”

Download a copy here

Contact for further details or telephone 020 8521 7817.  Bloggers especially welcome! Both authors of the piece, Mark Brown and David Floyd are available for interview and comment.


Mental health and work: Not a magic four letter word

The following is a speech I made to the Mental Health providers Forum AGM in 2008.  I’d completely forgotten about it until I was in a meeting recently and some said that they were there when I gave it.

The question of work and recovery is one that has the ability to inspire both visionary zeal and rancorous disapproval.  To some it seems to be self evident that people will have better lives if they are working, earning and enjoying a fulfilling professional life.  To others it seems as if people who are ill are being forced into jobs to get them off of benefits.

My own story isn’t too different from a lot of people’s.  After a number of years of being unwell without really considering myself to be ill, I finally had to drop out of university after a disastrous attempt to get a degree.  Very unwell, I found myself excluded, unable to claim benefits and at a loss as to what my future might hold.  I was twenty one.

Subsisting on benefits, my life entered a kind of grey period, where things never moved.  I was accessing treatments, and trying to achieve a level of being well, but still had no idea of where my life might go.  I was worried about the idea of work for a number of reasons:

  • I was worried that I would be sent to do work I wouldn’t be able to do.
  • I was worried that I wouldn’t fit in at work
  • I was worried that people would stigmatise me for my condition
  • And I was worried that the work I would end up with wouldn’t suit me as I didn’t have the qualifications to reflect my abilities.


But I was still stuck in this day-to-day existence where I wasn’t really moving on, and every month was taking my further from the world that friends and family existed in where two things; work and the money it brought in, were allowing them to do things that were interesting, to interact with others and to do things that were fun.

What couldn’t see was a way back into work from where I was at that point.

I actually found my way back into work through being involved first on a voluntary basis then a paid basis in a very small social enterprise, which set me off on the path to where I find myself today.

For me, it was getting back into work, slowly and step by faltering step, that helped me to move out of a grey period of uncertainty and stasis and into an active and rewarding period of which I am still reaping the benefits.

As I grew into my role, and them finally moved into my current position, I found myself thinking of myself less as a person with an illness and more as a person with certain legitimate limitations that I and my colleagues needed to be aware of and certain challenges that I had to overcome to get where I wanted to be professionally.

In essence, through seeing the fruits of my own actions realised in my working life, I began to hope for more in the future and moved into thinking of myself as someone who could achieve and prosper.

This is the real role of work in recovery.  Work in itself is not a panacea.  What really helps is the effect that the rewards of work can have and the feeling of rejoining the stream which everyone else is swimming in, of being part of life rather than at its side lines.  Finding the right work for you, your limitations considered, opens up life like a flower.  Like blood returning to a numb limb, money, personal relationships and the sensation of doing something and going somewhere do not solve the problems caused by your condition but they do bring feeling back and gradually begin to wake you up.

I think it’s the rewards of work, not something magic and intrinsic about work that makes the difference.

Social enterprise is, in theory at least, the more caring wing of business.  Concerned with creating outcomes beyond simple profit, it should be the perfect place for people with mental health difficulties to find work.

Many social enterprises can provide flexibility and support, and often being smaller organisation with less rigidly hierarchical structures and, on the whole tending to be much younger companies, a less ingrained sense of traditional practices.

In practice, social enterprises can also be les structured and be more pinched at the bottom line, requiring more from their staff.

To me, speaking professionally and as a person with mental health difficulties there are three main issues involved in the practicalities of helping people to access work as a way of supporting their recovery.

The first is adjustment.  What people with mental health difficulties need most when entering employment is a sense that their new employer is happy to take a creative approach to making sure that they can produce their best work within the limitations imposed by their condition.

In my own working life, my colleagues appreciate that I have a condition and that, to do my best work, there are some things in my professional life that need to be adapted both to make best use of my talents and also to work around the areas where my condition imposes difficulty.

If you think of it in the same way that you would think of the flexibility that working parents sometimes, you’re along the right lines.  A store of adjustment to be drawn upon as needs be.  A parent doesn’t need to rush off to the school everyday, but they might if their child is taken ill.  Similarly, in my own case, I don’t need to get to the office a number of hours later than everyone else every day, but some days I do.  It is not a matter of leniency or special treatment, just an acceptance of the fact that factors that are in play for someone with a mental health difficulty can be different to those of someone else.  We employ as similar approach with people who write for One in Four, adjusting deadlines or supplying additional research, doing what we can to make sure that the person can get stuff done.

The second important thing is trust.  People with mental health difficulties who are in work and those who have been away from work need to trust that their condition will be treated respectfully and even-handedly both by their employers and their colleagues.  There is nothing worse than feeling you are being done a favour, or feeling like you must beg for adaptations.  The conversation should always be a pragmatic one between equals.  When people are going through a crisis, as many people with mental health difficulties do, the effect of being ignored, fobbed off or not treated with due respect can often have a great effect.

The last one is hope and meaning.  Many conditions, my own included, can lead to an ebb and flow of energy and motivation.  What keeps someone going is the hope that things will improve and a certainty that things are going somewhere.  What we try to do with One in Four is to help people see that small positive steps can often lead directly or indirectly to large changes.  Feeling that you are having things done to you and that you are a passenger in a process rather than the person driving it makes it difficult for anyone to feel motivated.

For me, the most important thing to remember when discussing work and recovery is that work itself isn’t a magic four letter word; it’s everything that someone gains from being in work that is important.

Mark Brown is the editor of One in Four magazine.

Young People and Mental Health

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.


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 .

Debate: Should mental health anti-stigma campaigns be a priority?

In the first of our guest opinion posts, Judith Haire shares her thoughts on where money should go in mental health

I’ve experienced mental illness and been on the receiving end of unkind comments. I applaud the Time To Change anti stigma campaign run by the leading mental health charities Mind and Rethink Mental Illness.  One in four adults will experience mental health problems and one in four children. Stigma is a problem that can stop people seeking help, can erode already fragile self-esteem and confidence and can hinder recovery.

I am all for changing people’s attitudes and behaviour and removing the stigma associated with mental illness but we can take away the stigma and we are still left with the ever-growing problem of mental illness. I really can’t see the point of pouring endless sums of money into anti-stigma campaigns when this money could be deployed on researching the causes of mental illnesses and the best treatments for these illnesses

I believe the burden of mental illness in the UK is widely under-estimated. Poor mental health affects our ability to work, it affects our ability to have fulfilling relationships, it affects our physical health and our ability to have a fulfilling social life.

Poor mental health costs us £100 billion a year in the UK.

In one year there are 13 million working days lost to stress related illnesses.

A third of a GP’s time is spent dealing with mental health problems and around a quarter of people with mental health problems are taking prescribed medication.

Mental illness causes 15% of our country’s disease burden but only receives 5% of the total health research spending. £74 million is spent in a year on research into mental illness but this figure needs to be nearer £200 million over the next 5 years.

In fact, current spending needs to be trebled. The Department of Health and Comic Relief have given the Time To Change campaign a further £20 million – I would prefer this to be spent in different ways.

A strategic analysis of mental health research funding in the UK (Department of Health, 2005) identified some major gaps in research funding. For example, research into the promotion of mental health and well being and research into common mental illnesses like anxiety disorders and research into suicide.

More research is needed into the links between diet and mental health and there are more questions to be answered surrounding the diagnosis of schizophrenia

There is a need for laboratory and epidemiological research into the causes of mental health problems (genetics, environmental factors and their interaction).

More research is needed on the treatments for mental health problems and most importantly to look at interventions to prevent mental illnesses

We need scientists and researchers to look further into genetic aspects of mental illness and at developing newer and kinder treatments for mental illnesses; treatments that do not have devastating side effects like type 2 diabetes, obesity, cataracts, sedation, tremor, muscle rigidity, insomnia or fluid retention. These side effects are debilitating and can require specialist treatment and surgery.

Let’s reassess our spending and not make anti stigma campaigns the priority.

Judith Haire is a Sheffield University Politics Graduate. She is author of Don’t Mind Me (Chipmunkapublishing. 2008). She contributed to Mental Health Publishing and Empowerment by Jason Pegler (Chipmunkapublishing, 2009) and Our Encounters With Madness (Ed. Grant, Biley & Walker, PCCS Books, 2011). She has written for Mental Health Practice, Community Care and Your Voice (Sheffield) magazines.

Guest posts reflect the views of their authors and do not neccesarily reflect the views of One in Four magazine.

Mental health 2011: What did you think?

As is traditional at this time of year, One in Four is preparing a round up of the year for our readers and we want to know what you made of the year.

It’s undoubtably been a turbulent one for many of us, but we want to know what your mental health high points, low points and hopes for 2011 are.

You’ve got two weeks to send us your thoughts. We want:

  • One high point be it personal, political or other
  • One low point be it personal political or other
  • One hope for 2012


  • One thing you’ve learned about mental health in 2011, be it a personal realisation, something factual or something general.

We’d like it if you could keep your answers to a maximum of 200 words for all four questions in total.

You’ll also need to provide us with the name you’d want your comments to be published under and an email address.

If we publish your comments we’ll send you three copies of the Winter edition in which your comments will appear.

Send your comments to with ’2011 Thoughts’ as the subject line.

We need them by 24th November so get thinking!


Mark Brown, editor, One in Four magazine.


Is it a surprise ‘the mentally ill’ feel happiness?

I came across this interesting little snippet of research today: A team of Dutch positive psychologists claim 68.4% of people with ‘mental disorders’ that they studied claimed they “often felt happy” during the previous four weeks.

The link discusses the strengths and weakness of the study but as Ad Bergsma and his team write of their results: “The possibility of coexisting happiness and mental disorders is of clinical relevance… A narrow focus on what goes wrong in the lives of the client and forgetting what goes well, may limit therapeutic results.”

To many it may seem ridiculous that a study that recognises that people with mental health difficulties might also be happy or feel happiness is news. But is it?

We still tend, in public debate at least, to divide the world into those who have mental health difficulties and those that don’t. So there are people, and then there are those people.

A good example of this is the Daily Mail’s coverage of The Centre for Social Justice’s major intervention into the mental health public policy debate ‘Completing the Revolution: Transforming Mental Health and Tackling Poverty’

In the Mail’s article covering the launch ‘Care in the community is ‘a £100bn failure’: Mentally ill patients have been neglected for decades, says Iain Duncan Smith think-tank’ the opening paragraph sets a tone from which the rest of the article does not deviate:

“The controversial ‘care in the community’ approach to treating the mentally ill has been a £100billion failure, a report warns today.”

It goes on to insert a ‘same old, same old’ couple of paragraphs about violent mad people while acknowledging that the report it is covering refutes the high profile linkage of mental health and violence:

“But the big push came in the 1980s with the introduction of new laws giving mentally ill people more rights.

The policy has been blamed for allowing dangerous mental patients to roam the streets, and there have been high-profile killings involving care in the community patients.

But the study claims that the link between mental illness and violence is ‘vastly exaggerated’ and suggests that doctors are too quick to detain people unnecessarily or to put them on powerful ‘mind-numbing’ drugs.”

There’s a ‘those dangerous people over there’ attitude in evidence in the Mail piece that has its obvious results in outdated stigmatising ideas and prejudiced behaviour but there is also a much more subtle process of transformation at work in the way that the article is constructed.

Read as a whole, the piece (and many of the reader comments that follow it) position mental ill health as a country that you enter with no passport home. You cease to be a person with hopes, dreams, fears, relationships and achievements and become one of ‘the mentally ill’, a member of a strange and threatening tribe with incomprehensible practices and motivations who must be measured and discussed using arcane mechanisms and ideas. You become a problem that is dealt with by policy means.

It can be easy to forget the way that mental health difficulty is often perceived in public debate is there are passing mental health difficulties that people get over (like a kind of mental flu), the ones that people bravely battle through to arrive pretty much in one piece and back where they started, and the serious ones that completely change people and from which they never return. Neither of these cultural ideas really fit the actuality of mental health difficulty or have shifted very much from where they were when we had asylums and people desperately hid their difficulties under a blanket of shame.

The reality is that many mental health difficulties are disabilities. They’re things that get in the way of doing things that you want or need to do. Very often the challenges that you face as a person with mental health difficulties are as much social as they are medical. The things that you experience because of your mental health difficulty disable you in a world that is set up for people who do not experience the same. Something that would take a little adaptation or a tiny tweak can be the difference between having a fulfilling life and finding yourself excluded. You’re a person doing their best to play the hand that you’ve been dealt and trying to find the best way of getting from where you are to where you want to go. You might do things you enjoy on the way, or find things that you value. You might even have a laugh.

The ‘mentally ill’ of public debate don’t have those qualities. They can either be cured or are incurable. They sort of just hang about either causing trouble or needing to be looked after. They’re public discourse relatives of ‘the poor’, ‘the homeless’ and ‘the disabled’. They fill a rhetorical gap when someone needs to say something but doesn’t really have much actual experience of what they’re talking about, or many details to hand.

If you’re thinking of ‘the mentally ill’ you’re not really thinking of people, you’re thinking of a vague, hazy mass of malfunctioning humanity that needs to be somehow maintained or contained.

It’s hard to see human qualities in such ill-defined generalities. Which means a person might well be surprised that individuals in that pile of ‘the mentally ill’ that they’re having such trouble picturing with any clarity might have any feelings at all, never mind feelings of happiness.

Mark Brown is the editor of One in Four magazine.

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Opening Public Services: A mental health view?

If any of you were following the news yesterday, you may have noticed a major story unfolding.  No, not phone hacking, but David Cameron’s launch of the Open Public Services white paper.

Much delayed, the Open Public Services white paper is this government’s vision of how public services will be delivered in future.

In many respects it is similar to the NHS Reform Bill which has just finished its ‘pause’.  It sets out five principles that will guide public service reform.

These are:

  • Providing more choice
  • Shifting power from the centre
  • Ensuring diversity
  • Guaranteeing fair access
  • Delivering accountability

This is the government finally getting to the gristle of what a Big Society might look like.

But what does this mean for mental health?  It’s something that we’ve been thinking about since December 2010.  The eagle-eyed amongst you who have both been reading this blog and have been keeping up with the constant flow of government policies may have noticed that we’ve been saying stuff that has now become pretty relevant to what we who are concerned about making sure the mental health needs of people are met might do next.

Here’s three videos of me speaking about what the Big Society might mean for mental health that I did for the Mental Health Providers Forum’s Lightbox project, with links to some of the most relevant posts from this blog.

Our thinkpiece on mental health and Big Society commissioned by the NHS Confederation is scheduled for publication at the end of this month.  If you’d like a peek at a draft email

Here’s me:

In many ways, our conference in May was about this question too.  There’s a write up and video here

Here’s some relevant posts from this blog and from One in Four:

So what about the Big Society thing? From One in Four Winter 2010

Mental Health and Big Society: Opportunities?

Where is the frontline in Mental Health?

What do Red Tory Big Society ideas mean for mental health?

Who should pay for mental health?

‘Walking in two directions’: A mental health and Big Society dilemma

Adventures in mental health and Big Society: Making stuff happen

Risk – an idea big enough to stop change in its tracks

Seven steps to changing the world: Article from One in Four winter 2010 examining ways to start and run your own projects or ‘How to change the world, Do-it-Yourself style!’

A more measured response to the white paper itself in the next few days!

Mark Brown is the editor of One in Four magazine.

Subscribe to One in Four for £10.00GBP per year

One in Four reaches 3rd Birthday

For immediate release 7th July 2011

The trailblazing lifestyle magazine for people with mental health difficulties One in Four celebrates its 3rd birthday this month.  Written by people with mental health difficulties, for people with mental health difficulties as depression, bipolar disorder and schizophrenia with a distribution of 10,000 copies per quarterly issue, One in Four is a kind of social enterprise project that hasn’t existed before.

Social Spider CIC, the small London-based social enterprise that publishes One in Four have taken significant risks in getting One in Four to where it is now, a magazine with a significant readership that is changing how people see mental health difficulty.

Conceived and edited by Mark Brown, development director of Social Spider CIC and a person with mental health difficulties himself, the project has drawn praise while battling against the idea that people with mental health difficulties can’t do things for themselves and with a continual struggle to keep afloat during worsening economic conditions.

Says Mark Brown:  “Sometimes I can’t believe we’ve managed to keep going.  Breaking new ground with next to no money isn’t the easiest way to run a magazine.”

Mark Brown was shortlisted for Champion of the Year 2011 by mental health charity Mind for his work on One in Four.  Says Mark:  “I came to the world of mental health first as some one trying to find a way through my own difficulties.  In three years we’ve moved from people who had a good idea to developing new thinking, leading conferences and taking forward a new view of mental health.  It’s been a process that has involved deep lows and significant highs and which has taken me into areas that I would never have predicted for myself during my years of unemployment due to illness.  It’s often taken me close to my limits.”

Social Spider CIC, the small London-based social enterprise that publishes One in Four have taken significant risks in getting One in Four to where it is now, a magazine with a significant readership that is changing how people see mental health difficulty.

Says Mark:  “We’ve seen mental health publications start up, survive for a short time then disappear.  It’s not an easy thing to get right.  Doing something like a national magazine for people with mental health difficulties that isn’t an NHS project or a project carried out by a major charity was quite hard for people to get their heads around. There’s been a lot of times where our business heads have told us to stop but our passion for mental health has kept us going.”

Building on the experience of One in Four the company is developing other mental health related projects, including thinking about the future of mental health in ‘The Big Society’.  Social Spider CIC is working on a report about mental health and Big Society commissioned by The NHS Confederation to be published later this summer.

Says Mark:  “Through doing the magazine we’ve learned so much, met so many people and had so many conversations.  We see our job as keeping hope alive.  There’s a definite ‘next wave’ of thinking about mental health around the corner but it’s one that’s threatened by cuts.”

Notes to editors

  1. Mark Brown is available for interview on his own experiences as editor of One in Four, his thoughts on what’s next for mental health and his thoughts on what effects Big Society may have on the lives of people with mental health difficulties.  He can be contacted on or 020 8521 2264 / 077 2852 0116.  He is @markoneinfour on twitter.
  2. One in Four is a quarterly, England-wide magazine for people with mental health difficulties. It is published by Social Spider CIC.  Each issue contains a mixture of features, news and information that supports recovery, signposts services and communicates health messages in an accessible style. One in Four empowers people, gives them hope and combats exclusion, discrimination and stigma.One in Four is distributed throughout England and is available in GP surgeries, libraries, universities, Mind shops and similar venues. You can find out more about One in Four, read selected articles from current issues and buy a copy online at
  3. One in Four is available through subscription.  One in Four can be purchased as an individual subscription and organisations can by copies in bulk at reduced prices.  Both forms of subscription are available via the One in Four website
  4. The editor, Mark Brown, experiences mental health difficulties himself. (See The Guardian interview with Mark:

‘Walking in two directions at once’: A dilemma

A photograph of a a road marking showing two diverging arrowsWhile much of the debate about health in England has been focused on the progress (or not) of the health bill through parliament reorganising the way that health services are run in England, those of us involved in mental health know that there is more to services than the NHS.

As this excellent piece by Mary O’Hara in The Guardian this week illustrates, the current economic and political climate is posing smaller organisations significant challenges.

These are often organisations that have come into existence because they have recognised a need that the NHS was not meeting. These can be anything from therapy services to art groups to advices services. As I’ve said in a previous post, there is no single frontline in mental health. Mental health is something that touches on all areas of life.

At present there’s a feeling of hatches being battened down, of feet being stamped down quite decisively on the funding hose that used to carry the flow of money that previously kept smaller organisations in business. As I’ve said, despite glimmers of hope, there’s not as much money in mental health as there should be.

I was at an event discussing mental health and big society last week where there was a marked scepticism for the idea that large state organisations would release some of their budgets to fund and support organisations from the community and voluntary sector. The view was that when it came down to it, large providers would generally choose to look after the jobs of people already working for them, rather than lose the jobs and enable others to deliver the service.

It’s a good an honourable thing to try to protect the interests of the people that work for your organisation and a good and honourable thing to try to keep the show on the road. With the public sector going through a period of being ‘slimmed down’ by the current government, it’s understandable that public sector decision makers will be looking to prop up their own houses.

But is this what’s best for people with mental health difficulties?  And what about the community, voluntary and other organisations that fall outside of the public sector but which deliver well loved services?

It’s here that lies the dilemma of our title.

Working as we are at a time of much reduced available funding, many of us trying to make sure that people with mental health difficulties don’t lose out from this current situation find ourselves captured on the horns of a series of dilemmas.  In a mental health and Big Society discussion we had today as part of the process of refining our thinkpiece (out next month), a mental health policy specialist described this feeling as ‘trying to walk in two directions at once’ and it’s a good description of the dilemma many of us face.

Some of us believe that there are possibilities for the current situation, especially the set of ideas and possibilities arrayed around Big Society, to bring about positive change in the way mental health services are delivered. This can mean we find ourselves arguing that the public sector should share some of its funds. In essence we find ourselves saying ‘make cuts to the public sector and give the money to other places.’ This is something that many of us find difficult to say.

At the same time, it’s our impulse to campaign hard to minimise cuts to services, even when we may feel like those services are not meeting our needs. In essence, we feel as if we should campaign to protect services that we support in principle but which we actually don’t like in practice.

Many of us would also like to find new and better ways of meeting the needs of people with mental health difficulties and supporting people to find solutions that suit them to the challenges that they face Sometimes these methods might be less specialist, less stable or less expensive. A good example of this is setting up a regular social drop-in where people had a chance to meet and find common ground to replace a now-closed day service provision. We sometimes feel that by finding alternatives that work and speaking proudly about them we are somehow betraying the case for the funding of services that are more specialist or more expensive.

Similarly within the broader debate about the opening up of public services, many of us want to see the smaller local organisations that we use surviving, but not at the cost of other more traditional state services that we use. We do want more choice but not if that means reduced quality. Many of us want greater access to medical treatments and interventions, but not at the cost of the community, charity and voluntary organisations that we love and rely upon.

This moment of reorganisation and redefinition does present us with opportunities to take forward many of the things we’ve been wishing for in mental health (see this and this report from our conference in May for more) but at what cost?

With the quality of life for those of us with mental health difficulties at stake, the dilemma is not an abstract or theoretical construction.

Even if we look at this period as an opportunity to move thinking around mental health services and opportunities forwards, by using this moment pragmatically to further these aims, it’s still a period where we will have to decide to do one thing over another or to follow one path while declining to follow others.

How do we make those choices? And how do we make sure that it’s people with mental health difficulties that don’t lose out?

Mark Brown is the editor of One in Four magazine.

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In a mental health and Big Society discussion we had today as part of the process of refining our thinkpiece (out next month), a mental health policy specialist described this feeling as ‘trying to walk in two directions at once’ and it’s a good description of the dilemma many of us face.

‘Making stuff happen’: Adventures in Big Society and Mental Health #1

In which we borrow a room and ask people to come to a meeting and some do

A photograph of Walthamstow Town HallIn a meeting room in the really rather lovely Waltham Forest Town Hall, this afternoon saw the first meeting of Waltham Forest Mental Health Forum.

As some of you might know, we’ve been working on a thinkpiece funded by The NHS Confederation into what Big Society ideas might mean for mental health.

As we spoke about at our conference last month, the present moment is one that is filled with both challenges and opportunities.  The ‘big’ idea of the ‘Big Society’ is that local people are best placed to find solutions to local problems.  This comes at a time where shake-ups in local councils and the NHS are leading to reorganisations, repositionings and changed priorities and where money seems to be evaporating more quickly than the spray from Waltham Forest Town Hall’s beautiful fountains.

Part of the argument that we’re making in our thinkpiece, out in July, is that organisations, communities and public bodies are going to have to find new ways of making things happen if we hope to meet the same needs that we met previously.  Another part of the argument is that getting organisations and individuals together and thinking about we want to happen is the key to making sure that innovation continues in this difficult time and that, on the ground, people still have opportunities to have their needs met.

With that in mind, we did something quite simple in our home borough of Waltham Forest.

We called a meeting.

We contacted everyone that we could think of who might be interested in making sure that Waltham Forest is a borough that looks after the mental health of the people who live here and said: We’re organising a meeting to see what we can do together in mental health and what we want to happen next.’

Quite brilliantly, people turned up.  Attendees included a local councillor, people from the local voluntary sector, people from local community groups and people interested in mental health.

What we’ve seen is that areas where voluntary, community and public sectors work well together are areas where more stuff gets done.  I haven’t been able to find a better term than ‘making stuff happen’ to cover the complicated interaction between talking, planning, plotting, persuading, politicking and advocating involved in getting something from being a nice idea to something that actually happens.  Stuff seems to happen when you get people with ideas and people with knowledge together and get them talking (especially if some of those people have resources too!)

We intentionally didn’t set an agenda apart from having a chat to work out what we could do together.  We weren’t inventing anything new, just trying to get some people together in a new way.

For the first half an hour we waded through all of the acronyms and all of the past rights and wrongs of what the local NHS had and hadn’t done, what the local council had and hadn’t done and what we thought was happening to groups and organisations in the current funding climate.

So far, so much like rounds of other meetings familiar to people who have been involved in engagement exercises.

Then we got onto the interesting things: what can we make happen, how do we do it and who might help?  To do that we had to shift from the kind of meetings that we’d been used to, where discussion focused on what the council or the NHS should or shouldn’t be doing and into seeing ourselves as independent of that and able to decide to do what ever we wanted.

Once we got away from the equally import conversation about what the public sector should be providing when people are ill, we got onto the question of how we could make stuff happen to help people be well.  What emerged was that there was already lots of extremely interesting stuff happening in the borough.  What also emerged was that there was work to be done in making a strong case to the local authority for the importance of mental health as a public health issue but also a case that gave practical information and suggestions.

Lots of ideas got knocked about, included going forward with a directory of local groups, organisations and services.  This would have a dual purpose of making people aware of those groups but also providing a practical resource to begin engagement with local GPs.  Another included widening awareness of our newly minted forum to get larger amounts of people along and where that wasn’t possible talking to people and finding out their ideas, wishes and fears.  A third was the development of a vision for what we, people with mental health difficulties and voluntary and community groups, would like to see in the borough.  We always expect local authorities to know what should be done, but Big Society ideas suggest that we might be the ones with a better and more useful vision.  Coming together on an equal playing field as people who want to make stuff happen is the first step for that.

A fourth and even more exciting idea that came across was that through talking to people, we might be able to find ways of making small community level projects happen.  One attendee said that she’d love to put on a regular group for people to meet and that all she’d need was a venue.  It transpired that there was a newly launched community hub that might be able to provide it.

This was the important aspect of what we were talking about; our ability as individuals and organisations to find solutions to problems and meet needs by working together, networking and doing that slightly messy yet vital business of ‘making stuff happen’.

I know they’ve been happening in some places for years.  Alisdair Cameron spoke at our conference about how far advanced this method of making stuff happen is in the north east of England.

As we filed out and past the wonderful fountains the conversations continued, as I hope they will for months to come.

If we’re going to make sure people have the best mental health possible, these are the kind of conversations that we need.  I’m glad we managed to start one here.

How are things where you are?

Mark Brown is the editor of One in Four magazine.

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