The following is the introduction to a piece of work we’re currently working on for the NHS Confederation about the ways that the ideas suggested by The Big Society might help the NHS to make sure that people with mental health difficulties are in control of the services they receive and ways that those services can support people to make their own decisions about the directions that services, support and opportunities should take.
And don’t worry, the full piece discusses the necessity of funding, both for treatment and for community organisations.
Introduction
This discussion paper was prompted by the unfolding policy narrative of The Big Society and the potential outcomes it might have for people with mental health difficulties.
As a group that are already more likely to experience unemployment, other health difficulties and social exclusion, there is a distinct danger that as a Big Society approach is rolled out in geographical communities, people with mental health difficulties will find themselves disenfranchised or, at worst, actively acted against. It is important that the NHS recognises that the situation in wider society influences the outcomes for people with mental health difficulties in a way that it may not with other conditions.
The NHS needs to support and enable people with mental health difficulties to become actors rather than subjects. While this is already the idea in practice, it must extend into the more higgledy-piggledy real world.
Where such good work exists, we must find ways to support and nurture it. Where it does not we must find ways, in these difficult times, to make sure that it is not snuffed out before it begins.
Working with projects and organisations already rooted in the ‘real world’ of the community is the most obvious and most desirable way to do this, as this paper explores.
As authors we are approaching the Big Society question not as academics or public sector professionals but as a small social enterprise, Social Spider CIC, involved in making mental health related things happen in the community; a social enterprise run by Mark Brown, who has a mental health difficulty himself and created and developed One in Four magazine for Social Spider CIC and David Floyd, an experienced veteran of a number community-based projects and social enterprise thinker.
In the process of our work, we see many of the issues around mental health and wellbeing from both sides of the desk, working as much with other professionals and people with mental health difficulties as we do with professionals who are providing services.
While not all of us necessarily subscribe to the ideas put forward as part The Big Society agenda as it is developing, we all have a duty to make sure that people with mental health difficulties can work within new circumstances and structures to enjoy the best outcomes that they set for themselves.
The Big Society analysis grows from recognition of a number of significant challenges faced by the agencies and organizations 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 that 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 them services have been pushing forwards for over a decade.
While there are 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 the plans 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.
Opportunities
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 become 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:
- they can be the providers of services purchased by those with personal care budgets
- they can be the organisations that act as brokers and fixers for personal care purchasers
- 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 experience 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?
and
How can Big Society ideas help people with mental health difficulties do the things that they wish to do?
We’ve got some answers for these questions, but we’re sure that we have only scratched the surface.
Mark,
The moment I read ” The following is the introduction to a piece of work we’re currently working on for the NHS Confederation ” I seriously struggled to continue reading your blogpost as the ‘ piece of work ‘ term is so evocative of the old NIMHE jargon that the elite ‘Recovered’ Service User Consultants circa mid noughties peppered their conversations with thinking it made them sound more ‘managerial’ and important.
I know you aren’t that bad so continued reading but as this is a blogpost about the Big Society , a concept many people are very skeptical about at the moment because of its parentage , and you specifically highlight the problem of service users as ‘ dumb recipients’ of services and whatever, why haven’t you made it clear why and how the NHS Confederation came to feed you the ‘ piece of work ‘ in question? as I’d certainly like to know.
Are NSUN part of that ‘ We’ ?
I recall NSUN mentioning you expressing an interest in joint funding opportunities – sorry, I’m naturally curious and the NSUN site is , as you know, leaking its own and its precious few site users personal data anyway – and as it has the NMHDU link and well, Social Spider /One in Four are allegedly local community based it’s difficult to see why the NHS Confederation would be punting work your way at all not least because you are no more representative than I am and strangely enough , no-one from NHS Confed has ever contacted me ( or anyone else in community MH sphere I know ) to ask what I think about MH policy or the Big Society even though I’ve helped set up a charity and lots of online and community based innovations and online MH networks that engaged with people that cost, eh, nothing.
Innovation is expensive? Is it really Mark? Openness in MH has never been subjected to a Cost
People definitely need info on and opportunity to feed into future shape of mental health services, Big Society or not, but those providing the info also need to be upfront about their ‘involvement’ and interests too.
I’m also confused about who One in Four is actually writing for nowadays as the audience you were funded by Comic Relief to bounce ideas off clearly need more informative writing than this mate as you assume people know who you are, who funds you, who you’re partnered with , what Social Spider and the NHS Confed are and that the audience you are funded to reach is also familiar with that whole MH service user elite ‘ piece of work ‘ gig.
They’re not Mark.
Argue the case for a particular type of local activism /solution if that’s what you passionately believe in but be honest and open Mark , Social Spider follows funding . I don’t , I want disabled people , service users and the working poor to get whatever help is necessary and available and to highlight and help you realize that transparency , openness and choice are key to bringing about positive change and self-determination for those we profess to care so much about.
Fight the Power.
Sorry , i was going to say openness in MH has never been subjected to a real cost/benefit analysis for all the economic determinism about how much people with MH issues cost the nation. It obviously pays the MH system and those who defend it to ensure it remains secretive and choiceless otherwise it wouldnt be. That’s real economics.
The big society and mental health ill tell you a little story and this is a true one according to the dla people i cant look after myself that is soon to change for pip anyway but here is my problem and it a great big one currently i get middle rate dla and jsa and i alo have BPD where i have to be fit and mentaly ready for work well i refused a job the other day it was in a kitchen right so i get a sanction fair enuff i could not take the job i dont like people i like indirect contact i was raped etc and i was attacted in the kitchen not that long ago i dont have a problem with that sanction yer they have took money off me for not going for a job basicly so next come in the fun i complain and they send me anthere kitchen job and i siad i cant have them choices but she did not care and if i do not go for the job i will suffor another sanction so where are we at now going on a training corse for 13 weeks in agriculture i told her about my theropy but she siad that doesnt matter if i do not go my money will cease no more money so this is the bigger society this is the goverment helping me i canot work with people i have a proven track record of not working with people well that means i am in crisis i will explain this to my theropist i have wrote to my mp and she has promised to reply but im still waiting why am i in crisis becuase if i goto what they want me to goto i will end up either attacing them killing someone worse people do tend to wind me up easy and if i get hurt inside i probably could kill thats if i go or i have the old option of taking and OD this is what the govement has created how can i work i sleep 12 to 14 hours a day i dont leave my house inless i have to or and i was told i will never come off these tablets ever thegoverment in there changes dont care they want you to work at what ever cost including life and the dole dont care becuase goverment has told them if you dont get more people into work you will be sacked i dont see a solution out of this one onbe thing is for sure i refuse plain out blank to go on monday coming im sory if i paint a very black picture of the goverment and the bigger picture with mental health but this is the way it is for me