Mental Health ReformSelf-Directed Support, WomenCentre & Peer Support

Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ 7th October 2013 ￭ Perth, WA ￭ Western Australia Association for Mental Health (WAAMH)

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The Centre for Welfare Reform

• Welfare state is good - it is just designed wrong.

• We need to move from meritocratic paternalism, and instead respect human diversity & equality

• New thinking must promote justice, citizenship, family & community.

• Innovate to build practical alternatives

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1. Self-directed support works really well in mental health but has been slow to take off.

2. Working with women, as whole women, through relationships also works.

3. Peer support (not just peer support workers) has a tremendous impact.

4. Mental health is at least partly caused by social justice.

5. The future of mental health is to fund life, not services.

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1. Self-directed support

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We spend people’s money for them on things they wouldn’t

really buy for themselves

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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

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Transportation 13% Crafts 2%

Computers and accessories 12% Licenses/ certi"cation 2%

Dental services 11% Entertainment 2%

Medication management services 8% Vision services 2%

Psychotropic medications 8% Furniture 1%

Mental health counselling 8% Non-mental health medical 1%

Housing 7% Camera and supplies 1%

Massage, weight control, smoking cessation 5% Education, training, materials 1%

Utilities 3% Haircut, manicure etc. 1%

Travel 3% Pet ownership 1%

Equipment 3% Supplies and storage <1%

Clothing 2% Other <1%

Food 2% Total 100%

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Support needs to !t the person, not the reverse

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IT’S NOT ABOUT SPENDING MONEY - ITS ABOUT LIFE

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2. WomenCentre

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Mental illness intersects with many other social problems

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There are lots of services, but...

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Managing a serious health condition 64%Finding a safer place to live 27%Living with childhood abuse 51%Didn’t "nish 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%

Of 44 women working with WomenCentre:

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The multiple reinforcing erosion of personal resilience

Mental illness is linked to real poverty

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Knitting together the bond of trust

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Service label n Urgent problem n Real need n

Victim of domestic violence 55 Debt 50 Better self-esteem 64

Mentally Ill 39 Housing 48 To overcome past trauma 54

Criminal 35 Bene"ts 46 To manage current trauma 51

Poor Mother 33 Health 37 To stop being bullied 50

Misuses Alcohol 24 Rent 32 Guidance 50

Uses Drugs 22 Criminal Justice Advocate 24 Relationship skills 45

Violent 19 Dentistry 8 Mothering skills 26

Chronic Health Condition 16 Others 3 Others 1

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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.

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3. Self help

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Peer support is critical and will guide us to better solutions

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“Don't forget to tell them that we had our "rst PFG camping trip last Sunday - it was amazing... we are planning Mad Fest which will be our mental health festival for next July.  Music group started and we have our own band... we also now have a community garden. And we have started a partnership with the church to have the church hall to do other crazy things in - we are doing pull up a pew - taking a church seat with us to have a cuppa and a chat about how people are feeling. Just incorporating into a proper company and our Jude is now the Chair of Doncaster CCG's Mental Health Alliance (A woman who didn't leave the house for "ve years)”

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The future professional?

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4. Social justice

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1. Income inequality

2. Debt

3. Stigma

4. Multiple social problems

5. Real poverty

If mental illness is an illness is social justice the cure?

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Income inequality is correlated with mental illness

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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 !nancial problems (i.e. a third higher)

Relative risks for people in debt: alcoholism (2x), drug addiction (4x), suicidal ideation (2x)

Professor Martin Knapp, 2012 Tizard Lecture

Debt is correlated with mental illness

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Chick Collins on the ‘Scottish Effect’

Social stigma is correlated with mental illness

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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

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5. Mental health reform

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1. Where is the recognition of the social justice factors that impact on mental health?

2. Can we be con"dent in the effectiveness of medicine to treat mental illness?

3. Can we be con"dent in the helpfulness of the mental health system?

4. Do we know how often do our crisis responses make things worse?

Does our current response to mental illness make sense?

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These "ndings [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

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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

We ignore the social and economic dimension

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Many treatments lack supporting clinical evidence

http://clinicalevidence.bmj.com

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We often create more crises by inappropriate responses

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Annually, there are 10,000 people placed out of area for mental health reasons and approximately 11,000 people with learning disabilities are also placed out of area per year. Nationally, the National Mental Health Development Unit (NMHDU) estimated that out of area placements for mental health cost £690 million per annum, therefore the combined cost of out of are placements is likely to be more than twice that amount, that is over £1.5 billion (NMHDU, 2011). Of the total number of residential and nursing care placements for mental health each year, 22% are out of area.

Alakeson and Duffy, Health Efficiencies

We move people and money out of communities

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1. Peer support

2. Personalised support

3. Relationship work

4. Entitlements and control

5. A focus on supporting citizenship

We can see some of the main elements of a reformed mental health system

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Fund Life, not services.

...there is a role for services - but in an equal partnership with people and communities

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For more information:

Web: www.centreforwelfarereform.org

Twitter: @CforWR and @simonjduffy

Blog: www.simonduffy.info

Facebook: centreforwelfarereform

Campaign: www.campaignforafairsociety.org

© Simon Duffy. Rights Reserved. Full copyright details at www.centreforwelfarereform.org

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