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?
and
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.
