Logically personalisation and mental health are in perfect harmony - the fact that progress is so slow reflects deep imbalances of power, control and perception.
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Personalisation & Mental Health
1. Personalisation & mental health
exploring key ideas
Dr Simon Duffy - The Centre for Welfare Reform -
UCLAN & Mind - Manchester - 19 March 2013
2. Dr Simon Duffy
•Social innovator - e.g. personal budgets
•Philosopher - work on citizenship
•Advisor - Campaign for a Fair Society
The Centre for Welfare ReformReform does not mean cuts
and inequalityWelfare state is good, but designed
wrongNeeds more innovation, andRespect for citizenship,
families, community & justice
•Reform does not mean cuts and inequalityWelfare state is
good, but designed wrongNeeds more innovation,
andRespect for citizenship, families, community & justice
3.
4.
5. Ideology: grassroots to mainstream & beyond
The development of personalisation theory and
relevance to policy development and wider health
and social care practice will be discussed. The
interplay between economic need for reform and
market development will be explored and its
significance to mental health service users and
local service and support provision discussed.
and market development will be explored and its
significance to mental health service users and
local service and support provision discussed.
6. Know how to take things. Never
against the grain, though they’re
handed to you that way. There are
two sides to everything. If you grab
the blade, the best thing will do you
harm; the most harmful will defend
you if you seize it by the hilt.
Baltasar Gracian
7. “...the standard of justice depends on the
equality of power to compel and that in fact
the stronger do what they have the power to
do and the weak accept what they have to
accept.”
cited by Thucydides
8. Key points
1.Personalisation is ‘contested’
2.Mental health reform has been
slow
3.Problems are going to grow
4.Change may yet come
11. I used to work in the fashion design industry as a product developer
until I became ill. This was a hard time in my life. I was diagnosed
with paranoid schizophrenia...
...as I am now on the road to recovery my budget has reduced. I
have updated my plan myself and this has given me the opportunity
to talk about what I want for the future. The opportunity to be
creative is very important to me and is something that keeps me
well. I now receive a little support and a one off payment which I
use to help me to buy equipment to make jewellery. I hope that I
will eventually be able to teach other people how to make jewellery
to give something back. My goal is to start up my own jewellery
business and be financially self-supporting, and the recovery team is
helping me with this.
Without the support that I have I would still be wondering where my
life is going, but now I have hopes for the future. I would definitely
recommend considering a personal budget. You can really make it
work for you in a way that I didn’t know was possible. I feel lucky
that I have been able to get back some of the life I have lost.
From Health Efficiency by Alakeson & Duffy
17. Citizenship
is the key
1.Purpose - a life of meaning
2.Freedom - directing my own life
3.Money - having enough on which to build
4.Home - being where I belong
5.Help - that fits me
6.Life - getting stuck in
7.Love - getting it and giving it
25. Erving Goffman's Asylums (1960) arose out the time he spent
in 1955-56 at St Elizabeth's Hospital Washington DC, where
he observed at first hand the daily life of mental patients and
staff. he concluded that in the 'total institution' that asylum
was, doctors and patients were bound together in a
masquerade in which the first had to behave in authoritarian
fashion while the second enacted variations on the themes of
manic craziness: even if power lay with the doctors, both
colluded in a social order which perpetuated madness rather
than the vaunted and hoped-for cure.
From Mad, Bad and Sad by Lisa Appignanesi
26. • Funding for mental health services is
currently invested in the wrong things
• Improving mental health has more to do with
citizenship and community than with services
• Current systems of funding and
commissioning have made no difference
• Personalisation and greater community-focus
could change that
• Peer support will change that
27.
28. These findings [better long-term outcomes for schizophrenia in
developing countries] still generate some professional contention and
disbelief, as they challenge outdated assumptions that generally people
do not recover from schizophrenia and that outcomes for western
treatments and rehabilitation must be superior. However, these results
have proven to be remarkably robust, on the basis of international
replications and 15-25 year follow-up studies. Explanations for this
phenomenon are still at the hypothesis level, but include:
1. greater inclusion or retained social integration in the community in
developing countries, so that the person retains a role or status in the
society
2. involvement in traditional healing rituals, reaffirming community
inclusion and solidarity
3. availability of a valued work role that can be adapted to a lower level
of functioning
4. availability of an extended kinship or communal network, so that
family tension and burden are diffused, and there is often less negatively
'expressed emotion' in the family
Dr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countries learn from
Developing Countries? World Psychiatry 2006, 5: 21-24
29.
30.
31. Government doesn’t
always know best
[The ill-fated Pruitt-
Igoe housing
project]
32.
33.
34.
35. Of 44 women working with WomenCentre:
Managing a serious health condition 64%
Finding a safer place to live 27%
Living with childhood abuse 51%
Didn’t finish their education 76%
Recent experience of domestic violence 85%
Fractured family (for those with young families) 66%
Children experienced abuse (for those with children) 55%
Living with a severe level of mental illness 55%
Living with some mental illness 91%
History of drug or alcohol misuse 52%
Victim of crime 41%
Perpetrator of crimes 39%
Worried by debt or lack of money 65%
48. We spend people’s money for
them on things they wouldn’t
really buy for themselves
49.
50. • End of Disability Living Allowance
• Cuts in Housing Benefit & Council Tax benefit
• Reductions in Access to Work
• Reduced eligibility for ESA
• Increasingly intrusive testing by ATOS
• Introduction of Universal Credit
• Benefits reindexed to increase poverty
• End of Independent Living Fund
• Increased eligibility for social care
• Increasing bureaucracy in social care
• Reducing budget levels in social care
• Return people to institutions and care homes
• Increasing social care charges
• Increased taxes, e.g. VAT, Council tax
• and many, many other measures
51.
52. Mental health will deteriorate as
1.Inequality will increase
2.Stigmatisation will increase
3.Real poverty will increase
54. Some of this may be caused by practical aspects of
poverty, e.g. debt:
45% of people in debt have mental health problems
compared to 14% of people who are not in debt
Developing unmanageable debt is associated with
an 8.4% risk of developing a mental health problem
compared to 6.3% for people without financial
problems (i.e. a third higher)
Relative risks for people in debt: alcoholism (2x),
drug addiction (4x), suicidal ideation (2x)
Martin Knapp, 2012 Tizard Lecture
55. Some of this may be caused by psychological
aspects of poverty, e.g. stigma:
Chick Collins on the ‘Scottish Effect’
56.
57. Mental health spending itself may not decrease
much, but this is not necessarily a good thing
Rather than reducing inequalities itself, the
initiatives aimed at tackling health or social
problems are nearly always attempts to break the
links between socio-economic disadvantage and the
problems it produces. The unstated hope is that
people - particularly the poor - can carry on in the
same circumstances, but will somehow no longer
succumb to mental illness, teenage pregnancy,
educational failure or drugs.
Wilkinson & Pickett, The Spirit Level
61. Emerging themes in policy
1.Personalisation still has momentum
2.GPs may have more influence
3.LAs may have more influence
4.Social care will be slashed
5.PBR may make a difference
80. rethinking outcomes
LA Resources ‘Social Care’ Well-being?
NHS Resources Medical services Clinical outcomes?
Improved mental
Welfare funding ‘what works’
health
81. Rethinking commissioning
• Total place - the
Humpty-Dumpty
challenge
• Community sourcing -
individuals, communities
and local organisations
• Innovate - you can’t
move without changing
• Measure - focus on what
really matters
84. WomenCentre:
1. Start with the whole woman - gendered and holistic
2. Offer a positive and comprehensive model of
support - every woman is a one-stop-shop
3. Build a bond of trust - create the means for woman
to do real work together
4. Be a new kind of community - women, working
together, to improve lives and communities.
95. The victorious ‘Fabians’
We have little faith in the 'average sensual man',
we do not believe that he can do more than
describe his grievances, we do not think he can
prescribe the remedies
Beatrice Webb
96. The defeated ‘Distributivists’
We say there ought to be in the world a great
mass of scattered powers, privileges, limits, points
of resistance, so that the mass of Commons may
resist tyranny. And we say that there is a
permanent possibility of that central direction,
however much it may have been appointed to
distribute money equally, becoming a tyranny.
G K Chesterton
97. Honour can exist
anywhere,
love can exist
anywhere,
but justice can exist
only among people
who found their
relationships upon it.
Ursula Le Guin
98. 1. Human Rights - Better fundamental legislation
2. Clear Entitlements - Its ‘my budget’
3. Avoid Crisis - Family support, lower
thresholds
4. Full Access - No ‘special’ funding for services
5. Choice & Control - Freedom, capacity
6. Fair Incomes - Enough for citizenship
7. Fair Taxes - No ‘special taxes’, no charges
8. Sustainability - Rethink health/social care split
99. If you want to get more involved
1.Join the Campaign for a Fair Society
www.campaignforafairsociety.org
1.Subscribe to The Centre for Welfare Reform
www.centreforwelfarereform.org
1.Twitter users can follow #fairsociety