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.