Mental Health, Social Inclusion Mental Health, Social Inclusion & Co-production& Co-production

David Morris

National Social Inclusion Programme

Co-production in mental health Co-production in mental health - a fundamental value - a fundamental value

- but needs radically realigned thinking:

• ‘Community’ does exist and• policy co-constructs it.• People have multiple identities and• we need to engage with them all.• Independence may not trump interdependence..• Paid work - a very good thing, but not everything.

Policy contextPolicy context

Policy in MH defined by:

• Mental Health Strategy – ‘Modernising Mental Health Services: Safe, Sound and Supportive’ (DH 1998)

• National service framework for MH (DH 1999)• Choosing Health (DH 2004)• Improving the life chances of disabled people (DWP, DH, DfES, ODPM 2005)• ‘Our health, Our Care, Our Say’ (DH 2006)• Local Government and Public Involvement Bill (DCLG

2007)

Policy contextPolicy context

…and for social inclusion in mental health by:

• Mental Health and Social Exclusion (Social Exclusion Unit 2004) • Reaching Out: An Action Plan on Social Exclusion

(Cabinet Office 2006)

Key policy dimensionsKey policy dimensions

• Most disadvantaged groups: promoting independent living; improving lives by giving service users more choice and control - self-directed care; individual budgets; Direct Payments

• Communities: promoting health and wellbeing in context of the ‘public mental health’ (new commissioning framework published 7.3.07)

• All: involving public, patients, service users and carers in planning and delivery of care

Policy contextPolicy context

…and for social inclusion in mental health by:

• Mental Health and Social Exclusion (Social Exclusion Unit 2004) • Reaching Out: An Action Plan on Social Exclusion

(Cabinet Office 2006)

Published June 2004Published June 2004Office of the Deputy Prime MinisterOffice of the Deputy Prime Minister

“Social Inclusion for people with mental health problems is a moral imperative”

(Minister for Health, launching SEU report June 04)

“Our vision is a future where people with mental health problems have the same opportunities to work and participate in their communities as any other citizen”

(SEU Report p94)

Challenging exclusion - the vision Challenging exclusion - the vision behind the SEU reportbehind the SEU report

SEU Project – remit & timescalesSEU Project – remit & timescales

• How to enable more adults with mental health

problems to enter and retain work?

• How to enable social participation and access to

services?

• Feb 2003 to Mar 2004: consultation; -

• June 2004: publication

• Sept 2004: implementation starts

Less than a quarter of adults with mental health Less than a quarter of adults with mental health problems are in work - problems are in work - the lowest employment rate

among disabled people

LFS data for England only

0

10

20

30

40

50

60

70

80

1998 1999 2000 2001 2002 2003

whole populationphysical health problemsmental health problems

Main barriers

– fear of losing benefits

– employers’ attitudes

– fluctuating nature of condition

– low expectations of health

professionals

Social exclusion has multiple impactsSocial exclusion has multiple impacts

• What can happen when people or areas suffer from a combination of linked problems – unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown.

• Characterised by the inter - relatedness of problems that are mutually reinforcing; combined they create a fast moving, complex and vicious cycle.

(Social Exclusion Unit 2004)

People are excluded in many different waysPeople are excluded in many different ways

• low levels of participation in • FE/leisure activities

physical illness overlooked

not eligible to be juror or school governor

harassment complaint not taken seriously

financial services

hard to access

1/4 tenants with serious arrears at risk of eviction

Employment

Education

Volunteering

Arts and CultureFaith communities

Family/ neighbourhood

Sport/ exercise

Services

Sue attends the day centre and the clinicShe has 5 friends she sees at outpatients or the day centre

People can become very isolatedPeople can become very isolatedOuter circle: places where friendships start.Inner circle: People who matter

• 3 year programme from Sept 04 – 07, based at National Institute for Mental Health in England

• National and regional centres• Cross - sectoral; cross - government• National and regional activity in partnership• Linked to public health, mental health promotion, equalities programmes

National Social Inclusion ProgrammeNational Social Inclusion Programme

NATIONAL SOCIAL INCLUSION PROGRAMMENATIONAL SOCIAL INCLUSION PROGRAMME

NATIONAL LEVEL CENTRAL CROSS – GOVERNMENT TEAM

REGIONAL LEVEL 8 DEVELOPMENT CENTRES – Social Inclusion leads SE SW LON EM NE,Y&H NW WM E

Cross cutting work streams:

Workforce Development - Research & Evidence - Community Engagement - Criminal Justice - Inequalities

AFFILIATES NETWORK: 50 organisations - users, voluntary, professional

STIGMA/ DISCRIM’ ION

INCOME/

BENEFITSEDUC’N HOUSING

CTT’Y

PARTIC’N

SOCIAL

NETW’KS

DIRECT

PAYM’TS

EMPLOY- MENT

Community Participation Community Participation Day service modernisationDay service modernisation

is key componentis key component

Refocusing Day Services:– traditional day services provide specialist support

solely for those with mental health problems in a segregated day facility

– traditional day services often fail to meet the diverse needs of the community they serve

– being in work and having social contacts is strongly associated with improved health and well-being

Day service modernisation - Day service modernisation - three more policy documentsthree more policy documents

• ‘From segregation to Inclusion’:– Commissioning guidance on day services for

people with mental health problems• Supporting women into the mainstream:

– Commissioning women-only community day services

• Direct Payments for people with mental health problems - a guide to action

(all NSIP 2005)

Day service modernisationDay service modernisation

Modernised approach achieves 4 goals:

• Opportunities for social contact and support• Support to retain existing roles, contacts, activities.• Support to access new roles, relationships, activities.• Opportunities for service users to run their own

services and provide their own support All better achieved with co-production and community

bridge building in mind!

NSIP influencing widely across sectorsNSIP influencing widely across sectors& engaging communities& engaging communities

‘Together we can improve our health and well-being …

… What will be done: Tackle the social exclusion experienced by people

with mental health problems by bringing together local communities and citizens with mental health needs in partnership with the relevant public services

‘Together We Can’ (2005) Strategy for Community Engagement,

Home Office, Civil Renewal Unit

Co-production means…Co-production means… linking governance to social capital through linking governance to social capital through

realistic approaches to community engagement:realistic approaches to community engagement: ‘Rather than expect everyone to participate equally in

formal governance, we should try to make more people’s everyday civic engagement count by designing the formal governance in a way that taps into the informal spaces of community life that they routinely inhabit.’

Community Participation, Who benefits? (2006) Skidmore, P. Bound, K.

Lownsbrough, H. Joseph Rowntree Foundation

The informal spaces of community life that The informal spaces of community life that people routinely inhabit people routinely inhabit

The places with which people are already familiar – the … newsagent or post office hold the key to engaging them in governance activity. These places and the organisations that occupy them act as the everyday bridge between ordinary people and more formal governance activities.

Participation, Who benefits? (2006) Skidmore, P. Bound, K. Lownsbrough, H. Joseph Rowntree Foundation

‘The places with which people are already familiar ….

…also the setting for co-produced services?

Thank youThank you

www.socialinclusion.org.uk

david.morris@dh.gsi.gov.uk