VISION ANDPROGRESSSOCIAL INCLUSION AND MENTAL HEALTH

NATIONAL SOCIAL INCLUSION PROGRAMME

2009

Social inclusion is about getting people back to work but it is also about widerparticipationFor people with mental health problems to recover and rebuild their lives they need access to those social,economic, educational, recreational and cultural opportunities, and physical health services, that most citizens takefor granted.

Social inclusion is not just about accessSocial inclusion is not just about having access to mainstream services – it is about participation in the community, asemployees, students, volunteers, teachers, carers, parents, advisors, residents; as active citizens.

The need to work across traditional boundariesReducing barriers to inclusion requires integrated effort across government and non-government agencies atall levels, horizontally and vertically, influencing policy and practice through direct links to individual experience.

Social inclusion is supported through partnership workingThe whole is more than the sum of its parts. Through partnership working, organisations from all sectors canbuild the bridges required to support community participation, active citizenship and build social capital.

Not just talking about serious mental health problemsSocial inclusion is also a key issue for people with more common mental health problems. It is about prevention andmental health promotion: about maintaining support, building resilience and community wellbeing.

The public sector duty is an active duty, not a passive onePublic sector duties on physical and mental health disability provide for active promotion of equality and opportunitywithin the requirement to act on discrimination. Statutory measures to promote equality are key to eliminating thebarriers that exclude.

No challenge to exclusion can succeed without the full involvement of people with mentalhealth problemsA co-productive approach, working with people with experience of mental health problems, is essential at every levelof development and delivery.

A sense of personal identity, aside from ill health or disability, supports recoveryand inclusionPeople with mental health problems are more than just a diagnosis and have valuable contributions to make,not just needs to be met. Services should support people to access the opportunities available within the manycommunities to which they belong and to make valued contributions as active citizens.

To promote inclusion we need pathways from segregated service provision intomainstream servicesGroups or activities solely for people with mental health problems may reinforce segregation unless they arepart of a supported pathway into mainstream services accessed by everyone.

Healthy workplaces are necessary to mental health and wellbeingStress, depression and anxiety are the cause of more working days lost than any other work-related illness.Workplaces and learning environments should support good mental health by providing an accommodatingenvironment and showing a positive and enabling attitude.

TEN KEY MESSAGES

VISION AND PROGRESSSOCIAL INCLUSION AND MENTAL HEALTH

1 FOREWORD

2 EXECUTIVE SUMMARY

4 INTRODUCTION

6 CHAPTER 1 COMMUNITY ENGAGEMENT

12 CHAPTER 2 EMPLOYMENT

17 CHAPTER 3 LEARNING AND SKILLS

20 CHAPTER 4 HOUSING

23 CHAPTER 5 ARTS AND CULTURE

26 CHAPTER 6 LEADERSHIP AND WORKFORCE

32 CHAPTER 7 SOCIALLY INCLUSIVE PRACTICE: THE CAPABLEORGANISATION AND TRANSFERABILITY OF OUR WORK

38 ANNEX A RESEARCH AND EVIDENCE

40 ANNEX B PUBLICATIONS AND RESOURCES

41 ANNEX C ACKNOWLEDGEMENTS

CONTENTS

THIS REPORT SETS OUT THE WORK OF THE NATIONAL SOCIAL INCLUSION PROGRAMME(NSIP) AT THE NATIONAL INSTITUTE FOR MENTAL HEALTH IN ENGLAND, FROM THEINCEPTION OF THE PROGRAMME IN 2004 TO DATE.

NSIP has worked to implement and influence policy but with people at the centre. It has beenenormously fortunate in recruiting the willing and active participation of so many people withpassion, commitment, experience and skills from so many places and sectors over time.

Though simple in aim, thanks to the variety of systems through which we work and the richnessof the people for whom we work, inclusion is diverse in nature. In going about this work, it hasbeen important to resist reductionism; to reduce the complexity of individuals or theinterdependent nature of communities to a single element or objective, as part of the changeprocess, may achieve simplicity but it also risks an underestimation of the complexity of humanlife. Our starting point was to recognise this and from it, build broad consensus of purpose. Wehave tried to think and act ‘outside the box’, acknowledging the many accounts of people whouse mental health services that tell us the clinical or professional box is precisely the problem.These narratives have continued to guide action on social inclusion throughout the programme.

We express thanks to everyone who, over the past four years, has helped us to advance ourgoals. Though not surprised, we have been constantly impressed with the way people fromhighly diverse backgrounds have so readily brought wide ranging experience from multiplecommunities to bear, during the course of this work.

If that was our starting point, we must acknowledge that there is no finishing point. The challengeis continuing to effect cultural change, through the transformation of thinking and services acrosscomplex organisational boundaries. Whole person approaches demand whole system responses.This is neither simple, nor short-term. Having been well informed by the many examples of strongvalues-based practice that are incorporated in this report, we hope that we have made a goodstart. We need to make sure that these often inspirational approaches are positioned to inspireothers. Locally and regionally this is an agenda that needs to be led for the long haul, ensuringthat progress is sustained and shared through innovation in learning and evidence in practice.

As an issue of social justice, inclusion in mental health remains a moral imperative. Though this iswork in progress for the wider inclusion community, the people who individually and collectivelyhave contributed to our work have set a compass for its achievement.

David MorrisProgramme Director

1FOREWORD

THE NATIONAL SOCIAL INCLUSION PROGRAMMEHAS ALWAYS SOUGHT TO ENSURE THAT THE SOCIALINCLUSION AGENDA FOR PEOPLE WITH MENTALHEALTH PROBLEMS TAKES ACCOUNT OF THE MANYAREAS OF LIFE ON WHICH EXCLUSION IMPACTS.

In 2004, the Social Exclusion Unit’s report set out whatneeded to be done to address mental health and socialexclusion. This Vision and Progress report takes stock ofthe progress we have made and addresses new andfuture challenges in seven key areas.

COMMUNITY ENGAGEMENTSocial inclusion is not just about having access tomainstream services but about active participationin the community, as employees, students, volunteers,teachers, carers, parents, advisors and residents.We have:

� Encouraged day services to be ambitious, to act notjust as a window on to mainstream communities butas a bridge, whilst still providing a place for people tofeel safe and be mutually supportive.

� Helped increase the number of people usingDirect Payments in lieu of mental health services,resulting in more people now having greater choiceand control over the way in which they receiveservices and support.

� Highlighted the importance of adult mental healthservices recognising people’s parenting roles and thatyoung people can be carers too. Joint working acrosschildren’s and adults’ mental health services hashelped build the impetus to support joined-upthinking and approaches at a national level.

� Established the ‘Communities of Influence’programme which enables Foundation Truststo engage and lead their governors and membersto build the community capacity needed tostrengthen socially inclusive outcomes for peopleusing their services.

EMPLOYMENTWelfare systems can act as an enabler or be a barrierto inclusion, and stress, depression and anxiety are thecause of more lost working days than any otherwork-related illness. Workplaces and employers shouldsupport good mental health by providing anaccommodating environment and showing a positiveand enabling attitude. We have:

� Helped to increase employment opportunities forpeople with mental health problems. This includesthe publication of commissioning guidance onvocational rehabilitation and feeding in to ‘ReachingOut: An Action Plan on Social Exclusion’ whichled to the establishing of nine Regional EmploymentTeams (RETs).

EXECUTIVE SUMMARY 2

� Worked with Department of Health, Department forWork and Pensions and Cabinet Office colleagues ondelivery plans for the Public Service Agreement (PSA)16 and its implementation.

� Increased support for employers, such as:establishing and hosting of the Employer EngagementNetwork; ensuring that the RET initiative increasesorganisational capacity at a regional level to delivercurrent strategies and support stakeholders.

� Developed a mental health awareness trainingpackage for trade union representatives.

EDUCATION AND SKILLSEducation, learning and skills are all important in theirown right and can act as a pathway to potentialemployment. We have:

� Supported the Partnership Programme which haschanged the climate of support for learnerswith mental health problems and has consistentlyadvocated for them at a strategic level.

� Contributed to the 2008 follow-up to the Learningand Skills Council’s 2006 strategy, providing arenewed vision to promote the social and economicinclusion of people with mental health problemsthrough improved access to, and success in, learningand skills.

HOUSINGHousing is central to providing a stable base from whichpeople can seek and make the most of socially inclusiveopportunities. We have:

� Established the Housing Reference Group whichprovides advice, and shares and coordinatesinformation on new policy developments.

� Worked with the Department of Health, Communitiesand Local Government and the Cabinet Office on thedevelopment and implementation of the new PublicService Agreement (PSA) 16.

ARTS AND CULTUREParticipation in the arts and cultural activity can givepeople a positive alternative identity to that of ‘serviceuser’ and help them to be part of the wider communityby increasing self-esteem, confidence and socialnetworks. We have:

� Contributed to research to better understand thebenefits of taking part in arts projects for people withmental health problems, resulting in a governmentworking group on arts and health.

� Developed good working partnerships with a numberof national arts bodies to raise awareness of: socialinclusion and mental health; arts organisations asemployers of people with mental health problems;and the need for staff training.

LEADERSHIP AND WORKFORCEOrganisations, teams and individuals sometimes requireguidance, support and leadership to strengthen theircapacity for socially inclusive practice. High aspirations,organisational support and a ‘can-do’ attitude are key toimproving social inclusion outcomes. We have:

� Undertaken the Delivering Effective Local Leadershipfor Social Inclusion (DELLSI) initiative.

� Established a commissioning network for socialinclusion to support effective commissioning practice.

� Worked closely with four Expert Advisors whohave experience of mental health problems and aReference Group of people with mental healthproblems and carers to ensure social inclusionpractice is developed in a co-productive way.

SOCIALLY INCLUSIVE PRACTICE: THE CAPABLEWORKFORCE AND TRANSFERABILITY OF OUR WORKBoth individual and organisational capabilities arerequired if socially inclusive practice is to be embeddedand sustained. There is considerable potential forapplying lessons learned in the mental health domain toother efforts to address social exclusion.

� Strong leadership is needed to ensure change withinand beyond services and to sustain best practice.

� Social inclusion requires an overarching view of policy,funding and implementation that cuts across a rangeof sectors including employment, communities,housing, learning and skills, and civic responsibilities.

� The potential for synergy across other client groupsneeds to be realised.

3

“HAVING BEEN A SERVICE USER FOR 18 YEARSI HAVE BEEN SOCIALLY EXCLUDED FROM SO MUCHBY THE MERE FACT THAT I HAVE A MENTALILLNESS.WHILST MANY OF THESE EXCLUSIONSREMAIN, I HAVE BEEN EMPOWERED TO TRYTO ENSURE THAT FURTHER EXCLUSIONS ARE NOTPLACED UPON PEOPLE LIKE ME.”1

‘Vision and Progress: Social Inclusion and Mental Health’sets out the achievements of the National Social InclusionProgramme (NSIP) since the 2004 ‘Mental Health andSocial Exclusion’ report by the Social Exclusion Unit(SEU).2 It recognises the commitment and hard work of theteam (past and present), its Expert Advisors andReference Group, as well as all those partner organisationswho have contributed to these achievements.

This report reviews the last four years in light of ouractivity at national, regional and local level. It highlightsthe progress that has been made across the statutoryand non-statutory sectors and highlights the additionalvalue of work beyond our formal remit; work that hassought to reach out to non-traditional services andpartners to champion the social inclusion agenda insometimes unfamiliar areas.

It also provides an assessment of the remaining andcontinuing challenges that need to be addressed forimproved outcomes for people with mental healthproblems. This is based on feedback from national andregional social inclusion leads across mental healthand health services, local authorities and regional bodies,as well as information gathered through an analysisof progress and gaps with provider organisations at alocal level.

This report is intended to be a further resource forpolicy makers, regional agencies and services to ensurethat this important work is sustained and developed inthe future.

BACKGROUND TO THE NATIONAL SOCIAL INCLUSIONPROGRAMMENSIP is a programme within the National Institute forMental Health in England (NIMHE) as part of the CareServices Improvement Partnership (CSIP) and it hasoften taken a high level and strategic cross-governmentrole. The programme’s original remit was to coordinatethe implementation of the SEU report. More than20 government departments and a range of externalagencies have worked together with NSIP tosuccessfully implement the report’s 27 cross-cuttingaction points. However, NSIP’s work has highlighted howcomplex the reality of this really is. Due to the multiplicityand diversity of the wide number of agencies at all levels,there still remains work to be done locally and nationallyto ensure that individuals and services are maximisingopportunities for social inclusion.

Effective inclusion will contribute significantly to reducingdiscrimination, and NSIP has worked closely with Shift,a five-year programme to tackle stigma and

INTRODUCTION 4

discrimination (and responsible for action points 1– 4 inthe SEU report) by working in partnership on aspects ofthe employment agenda, having co-terminus locationsand shared expert advice.

In 2006, the Cabinet Office invited NSIP to contribute tothe development of the Social Exclusion Action Plan 3

which led to our overseeing the creation of dedicatedregional employment teams (RETs) to provide furthersupport for the implementation of good practice on theemployment of people with severe mental health problems.

The programme has also worked with the Cabinet Officein developing and implementing the Public ServiceAgreement (PSA) 16 on employment and settledaccommodation outcomes for people with severe andenduring mental health problems, supporting action toensure that the PSA drives change at local level.

THE NSIP APPROACHWhen NSIP was first established, its primary functionwas to implement policy. We have however, ensured thisimplementation is linked back in to further policydevelopment. Our focus is therefore on both what ittakes to turn policy into practice and reality on theground and also on policy development and regulatoryframeworks which support positive outcomes. Over thecourse of the past four years, we have contributed to thedevelopment and delivery of a wide range of policy, usingthe expertise in the team and our co-productiveworking approach to establish a broad understanding ofwhat ‘good’ policy looks like from a social inclusionperspective and how it can work effectively to promotethe core aims of social inclusion.

As part of NIMHE, NSIP is also connected to theDepartment of Health. We have brought together abreadth of skills and expertise in mental health and socialinclusion, as well as political and strategic experience.Our small central team comprises secondees drawnfrom across government, including the Department forWork and Pensions, the Department for Innovation,Universities and Skills, Communities and LocalGovernment and the Cabinet Office.

Central team members and regional colleagues fromNIMHE/CSIP development centres have workedtogether as equal partners in the national programmeand this has allowed the team to become a hub ofexpertise through which ideas and action haveinfluenced emerging policy. This is turn has enabled theinclusion agenda to be embedded across life domains ina way that addresses the needs of the most excluded.The network of regional social inclusion leads has also

brought an in-depth understanding of regional prioritiesand pressures. They have identified good practice andaccelerated policy implementation by helping us totranslate policy into practice for services and individualsat regional and local level.

The team also includes people from both the voluntarysector and professional bodies to ensure that ourfocus is on the most important and influential areas ofpolicy and that staff working in the sector have resourcesand information to help inform improved practice onsocial inclusion.

We operate in a co-productive way, ensuring that our workis informed by people who use services themselves, andcarers. The Expert Advisors are a small group who workwith NSIP to ensure the involvement of people with mentalhealth problems is maximised across the programme.They also advise on the direction of certain initiatives andprovide specific expertise on a range of inclusion areas,including day services, arts, education and employment.

“I find that much of the knowledge, skills and perspectiveI have acquired at the national programme around policy,strategy, new ways of thinking and good practice havemotivated and inspired me to constantly look foropportunities to implement and develop the values andprinciples of NSIP.” 4

The Reference Group is a wider network of people whouse mental health services and carers. It representspeople with interests that span the inclusion agenda fromall regions across England. Their role is to provide updatesfrom regional and local perspectives, disseminate nationalmessages and respond to government consultations sothat people can influence the services they receive.

We have also enabled richly diverse partners to cometogether through extensive arrangements for jointprogramme work with over 50 affiliated voluntary,academic and professional body organisations. Thesehave committed funding and resources to theprogramme, without which our successes would not beso many or varied.

The following chapters consider the impact that NSIPhas had in a range of social inclusion policy areas. Theyhighlight the considerable progress already made, whatthe remaining challenges are and what more needs to bedone both now and in the future.

5

1 NSIP Expert Advisor

2 Office of the Deputy Prime Minister, 2004, Mental Health and Social Exclusion,Social Exclusion Unit.

3 Cabinet Office, 2006, Reaching Out: An Action Plan on Social Exclusion.

4 NSIP Expert Advisor

VISION

People need to engage with the wide range of communitiesthat they rely on for their incomes, social support, self-expression and sense of continuity; these include communitiesof place (neighbourhoods), common interest, and the majorlife domains such as employment, education and housing.For this to be successful, services and opportunitiesneed to be accessible, well organised, stable and secure.Our vision is that:

� Everyone is supported to access the opportunities availablewithin the many communities to which they belong.

� Everyone understands and appreciates the mutual benefitsof contributions made by people with mental health problemstowards creating and sustaining a positive community.

� Mental health services will work with individuals andcommunities to promote active civic participation andeffective social support.

� There will be equal opportunities for active citizenship,increased social capital and less unwanted servicedependency.

COMMUNITY ENGAGEMENTCHAPTER 1 6

7

blueSCIblueSCI, Trafford, is an arts and cultural centre thataddresses segregation by opening its doors to a rangeof mainstream organisations and the general public.Alongside blueSCI’s reception sits a well-equippedinternet café, which is open to everyone in thelocal community to use. By arrangement, anyone canalso use the professionally equipped music studiodownstairs. The inclusive approach at blueSCIextends to mainstream local organisations as well,with several partners including Jobcentre Plus,Trafford College and a local housing association.In addition to this, a wide range of communityorganisations regularly run sessions within the building.www.bluesci.org.uk

PROGRESS SINCE 2004This chapter sets out the progress that has been madein implementing and developing policies to reducedisadvantage in the areas detailed below. It also set outhow the process of removing the barriers that inhibitpeople with mental health problems from achieving astable base in life has been developed.

DAY SERVICESDay services have played a valuable role for many peoplewith mental health problems. They provide a placeto go, people to see and something to do. However,they have often not been successful at reaching a widerange of people or enabling them to move on andaccess resources beyond mental health services.

Many services, which have historically provided bothsegregated activities and a safe social environment, arenow focused much more on supporting people toengage with their local community and the resourcesand activities within it. This means that the term ‘dayservices’ has become somewhat misleading as activitiesmay take place in the evenings as well as during the day,and are often very different in nature from those thatpeople expect a day service to offer. Indeed many dayservices have re-named themselves as ‘communitysupport’ or ‘community resource’ services in recognitionof their changed role.

NSIP has led the work on modernisation of day serviceswith the publication, in February 2006,5 ofcommissioning guidance on day services for people withmental health problems. It sets out the components thata modernised day service could incorporate andexplained how commissioners could work towards them.This guidance was linked to the Department of Healthpublication ‘Supporting Women into the Mainstream’.6

Eighteen months later a review of services 7 was carriedout to provide a snapshot of progress against the criteriain the commissioning guidance. The review identifiedwhere improvement had been made, highlightedcommon issues and the approaches to addressing themand provided examples of good practice.

“Having more things in my life has given me the reasonto be more independent.” 8

So far, the modernisation agenda has been primarilyfocused on resources for providers and commissioners.In response, NSIP produced ‘How will my newlyredesigned day service help me?’9 a booklet specificallyfor people using day services that are facing changes tohow they are run.

Day services have also been concerned with working outhow to measure and demonstrate socially inclusiveoutcomes. To address this we produced a Day ServicesOutcomes Framework.10 Reflecting the different lifedomains and functions of mental health day services, itaims to help commissioners and providers to monitor,evaluate and measure the effectiveness of services forpeople with mental health problems using a number ofindicators. The framework was tested in several dayservices across England during 2008. As a result of thiswork, and responding to proposals that the frameworkbe widened out beyond day services,11 we haveidentified the need for an outcome measurement tool,which is currently in development and which will bepublished in spring 2009.

In providing leadership on day services modernisation,NSIP has promoted a role for services to facilitate peersupport for others who have shared similar experiences.We have encouraged the development of user-run dayservices and the use of peer support and co-productiveapproaches in day service delivery.

However, challenges within the modernisation agendaremain. Anxiety about change is common amongstpeople who use services but it is also felt by day servicesstaff themselves and provider organisations. It cansometimes be difficult for services to develop a moreappropriate balance of provision that involves both peersupport and support to engage with wider communities.This is particularly challenging if commissioners andproviders are not assisted to achieve this goal. Manyhave felt isolated and value contact with others whohave shared some of their experiences and from whomthey can learn.

In order to address this, we have established a DayServices Modernisation Network. This collaboration, thefirst in which large voluntary sector agencies haveworked together on this agenda, brings togetherRethink, Richmond Fellowship and Mind with NSIP, toprovide a discussion and learning forum on day servicesmodernisation for senior managers in voluntary andstatutory sector provider and commissioningorganisations. A further learning and information networkhas been put in place to support the disseminationof key messages and resources. This wider networkcomprises some 600 people working on day servicemodernisation, including more than 80 commissioners.

DIRECT PAYMENTS AND PERSONALISATIONDirect Payments are known to offer people with mentalhealth problems greater flexibility about their ownsupport arrangements and the means by which they canbe met. In particular, Direct Payments can enable themto more easily access mainstream services, helping topromote independence and greater inclusion in localcommunities by offering opportunities for employment,education and leisure. However, take up in previousyears has been low (see below).

The SEU report 12 recognised that giving people greaterchoice and control over the way in which they receivedservices and support, particularly through themechanism of Direct Payments, was an important wayto combat exclusion. In response to this, NSIP oversawthe development and publication of ‘Direct payments forpeople with mental health problems: A guide to action’ inFebruary 2006.13 It set out good practice in makingDirect Payments more accessible to people with mentalhealth problems and encouraged local authorities,PCTs, mental health trusts and non-statutory providersof mental health services to make Direct Payments astandard option within mental health services.

This was then followed by an additional publication,14

which set out specific information for people eligible touse mental health services, and carers. It was compiledwith the support of people and organisations involved inmental health services and a wide range of DirectPayments activity. NSIP has also been involvedin training and development activity at more than 40training events and forums including people who usemental health services, carers, Direct Payments supportstaff and commissioners.

“More than anything Direct Payments has givenme choices and has helped no end with social inclusion.My companion has introduced me to new friends and

I am finding it far easier to socialise with people,my family have also noticed that my social skills areimproving all of the time. I would not hesitate inrecommending Direct Payments to other service users,Direct Payments opens doors and improves lives.” 15

Over the past four years there has been a sustainedincrease in the numbers of people using Direct Paymentsin lieu of mental health services. The most recentfigures for March 200816 show a 62% increase over theprevious year taking the number to a total of 3,373,with only four local authorities not making any payments.This compares very favourably to the 520 made atSeptember 2004, when one-third of all local authoritiesin England were not making any. The findings from therecent Individual Budgets pilots17 have shown thatpeople with mental health problems had the greatestincreases in both social care and psychological wellbeingoutcomes, with 71% choosing Direct Payments as theway to manage their money.

The Department of Health has indicated that it considersmental health services to be suitable for initial work onPersonal Health Budgets. NSIP is already working withthe related ‘Staying in Control’ initiative that providessupport to the PCTs and local authorities which haveselected mental health as an area for the introduction ofPersonal Health Budgets alongside social care PersonalBudgets.

Integrating our work on Direct Payments within theDepartment of Health’s personalisation agenda has ledto a range of initiatives, notably the production of a guideto implementation of Personal Budgets within mentalhealth services, and to support this a DVD reflecting theexperiences of those using Personal Budgets in mentalhealth. Also, in partnership with the North Westdevelopment centre and ‘In Control’ (a nationalprogramme to increase the control exercised by peoplewho need support over their own lives and fulfil their

CHAPTER 1 COMMUNITY ENGAGEMENT 8

‘IS IT FOR ME?’ AND ‘I’LL GIVE IT A GO’The ‘Is it for Me?’ and ‘I’ll give it a go’ projectcombines basic skills learning with the opportunityto consider Direct Payments as a support option.This training resource is now being disseminatednationally. It recognises the importance ofDirect Payments as a means of developing ‘self-directed support’ and thereby reflects the significanceof Direct Payments as a contribution to policydevelopments in ‘personalisation’.

roles as citizens) we developed and now maintain thenational mental health and personalisation group. NSIP’semployment, housing and personalisation policy leadshave worked with ‘In Control’ as part of the broaderdiscussion on how best to achieve integration of work onpersonalisation with that of inclusion.

Additionally, NSIP has played an important role inreviewing the exclusion criteria for Direct Payments,including those that relate to certain sectionsunder the Mental Health Act. This issue has recentlybeen consulted upon and the findings are due to bepublished in 2009.

However, some challenges remain. The roll out ofIndividual Budgets should take account of the lessonslearned from the implementation of Direct Payments forpeople with mental health problems, otherwise the riskis that their low take up will be repeated and people withmental health problems will be further excluded.The personalisation agenda should work to ensurethat support is available to enable people with mentalhealth problems to exercise more choice and experiencegreater dignity.

FAMILIES AND CARERSParental mental health problems can have a significantimpact on families, both in terms of a parent’s wellbeingand family life overall.

The ‘Action 16’ steering group was set up to oversee theimplementation of action 16 of the SEU report18 and wasjointly led by NSIP and the Social Care Institute ofExcellence (SCIE). Its broad membership included arange of government departments, voluntary and thirdsector organisations and PCTs. The group modelled jointworking across children’s and adults’ services andhelped build the impetus to support joined-up thinkingand approaches at a national level. The cross-cuttingnature of social inclusion policy supported this approachand the diverse, informed membership combined theskills and the overview necessary to bridge the dividebetween children’s and adults’ policy and services.It also provided a mechanism for reducing duplicationand adding value to other work streams, including theCare Programme Approach review.19

The relationship with SCIE has also been of criticalimportance. SCIE led the three-year research anddevelopment programme on parental mental health andchild welfare, now nearing completion with theproduction of cross-cutting health and social carepractice guidance due for publication spring 2009.

NSIP also contributed to the Cabinet Office’s cross-government Families at Risk Review,20 which found thatfamilies often do not get the most effective support whenthey need it most and that when parents face a numberof difficulties in their own lives, such as mental healthproblems, the impact for both themselves and for theirchildren can be severe and enduring.

“You want your mum when she’s ill, especially whenyou’re just a kid.” 21

The experience of the ‘Action 16’ partnership shows usthat involving children, young people and their parentswho ‘tell it like it is’ is crucial to understanding the needsof families, identifying service improvement issues andmotivating and raising awareness amongst providers andpolicy makers. The challenge to services is fundamentallyone of listening actively to the stories and experiences ofall family members including children and young people.

TRANSPORTWithout appropriate and accessible transport peoplewith mental health problems are at risk of being furtherexcluded from a range of community opportunities.

The early implementation phase of the SEU report22 hasseen mental health included within the 2004 Departmentfor Transport’s ‘Technical Guidance on AccessibilityPlanning in Local Transport Plans’. In response, LocalTransport Authorities (LTAs) included accessibilitystrategies within their Local Transport Plans in March2006. Regionally, good practice has been identified inthe West Midlands by the CENTRO authority area(Birmingham, Solihull, Coventry, Walsall, Wolverhampton,Sandwell and Dudley).

A review of concessionary travel has also beenundertaken by the Department for Transport resulting inthe Concessionary Bus Travel Act 2007 23 andaccompanying guidance.24 However, further work needsto be carried out in relation to the review to ensuregreater consistency in embedding the eligibility criteria

9

PARENTS IN HOSPITALThis review of contact arrangements between parentsin mental health settings and their children identifiesthe need to improve visiting arrangementsand facilities, and the support offered to parents.The findings draw on data from Mental Health ActCommission visits, hospital staff and importantly,parents and children themselves.www.barnardos.org.uk

across all local authorities so that people with mentalhealth problems are not further excluded.

At a local level, we also recognise that more needs to bedone so that services can develop and maintainpartnerships with travel providers to ensure that the rightinformation about public transport is available and thatany future policy development does not impactnegatively on people with mental health problems.

CIVIC PARTICIPATIONCivic participation is key to enabling people to engagewithin their own community. With Communities andLocal Government (and previously the Home Office)identifying community engagement as a priority, it hasbeen essential to ensure that the policy developmentprocess represents the needs of people who are on themargins of active citizenship. NSIP worked with thesedepartments, the (then) Disability Rights Commissionand organisations such as RADAR to ensure theinclusion of people otherwise excluded because ofdiscrimination from civic opportunities. As a result,‘Together We Can’, the government strategy oncommunity engagement now addresses the risk ofpeople with mental health problems being excluded fromlocal civic structures. NSIP has continued to influencethe preparatory processes behind the forthcomingCommunity Empowerment Bill.

Following identification by the SEU of certain institutionalareas of civic participation from which people withmental health problems were being systematicallyexcluded, such as jury service and school governance,NSIP has worked with relevant agencies to pursue theremoval of constitutional barriers. This includescontributing to the development of a consultation on juryservice eligibility criteria (publication expected 2009).We have also seen the revision of school governanceregulations which clarify the disqualification criteria on

mental health grounds. This has been published onGovernorNet 25 but more needs to be done to raiseawareness of the revision with Local Education Authoritiesand to promote the positive contribution that people withmental health problems can make to civic institutions.

CRIMINAL JUSTICE SYSTEMNSIP has overseen the completion of several of thecriminal justice action points from the SEU reportbut there have been many challenges in this area whichhave impacted on the successful implementation ofthese action points such as the mental health awarenesstraining for probation and police officers. Thesechallenges include the division of duties between theHome Office and Ministry of Justice in May 2007, themerging of strategy across prison health, offender healthand community pathways throughout 2007/08 and theamalgamation of the police training organisationCENTREX with the National Police Improvement Agency.

Furthermore, the Bradley Review, on the treatment ofpeople with severe mental health problems in thecriminal justice system (expected spring 2009), is likely toset a new strategic direction. This should provide theopportunity for those working in criminal justice agenciesto become knowledgeable of the needs of people withmental health problems and how to respond to them.

‘COMMUNITIES OF INFLUENCE’ PROGRAMME

“The Communities of Influence programme has been ashared journey of discovery with other Trusts.” 26

The creation of Mental Health Foundation Trustsprovided different opportunities for influencing socialinclusion outcomes across trusts and communities.This is a result of constitutional changes to allow for theappointment of governors and members from widermainstream community audiences. In response, NSIPhas created the ‘Communities of Influence’ programmein partnership with the Pacesetters programme in theDepartment of Health’s Equalities and Human RightsGroup and the University of Central Lancashire (UCLan).

The programme seeks to enable Foundation Trusts toengage with and lead their governors and members inbuilding the capacity of mainstream organisationsrequired to strengthen socially inclusive outcomes.It involves trusts enabling their local communities tobecome effective in securing and sustaining the socialinclusion of their fellow citizens with significant mentalhealth problems. There are currently 14 FoundationTrusts in the practice network within ‘Communitiesof Influence’.

CHAPTER 1 COMMUNITY ENGAGEMENT 10

‘ALL ABOARD’ PROJECTThe ‘All Aboard’ project with Birmingham and SolihullMental Health NHS Foundation Trust hasincorporated the development of a DVD for train andbus drivers, information road shows at Trust locationsand work with Community Safety Teams. People withmental health problems were identified as a targetgroup to benefit from the Accessibility Plan (byfocusing on the needs of those using mental healthfacilities) and addressing these specific needs withinthe Local Transport Plan.

The project, running initially until April 2009, consists ofan action learning set, followed by a series of trust-based development activities to identify and shareinnovative practice, tailored to each site. A final nationalconference in April will review what has been achievedand showcase how social inclusion and communityengagement plans are to be embedded into the Trusts’corporate goals.

CONCLUSION AND PROPOSED FUTURE ACTIONNSIP’s day service modernisation networks represent themost comprehensive picture of mental health dayservices and the most effective context for supportingthe development, available. It is important that theyare supported to continue to provide a platform forshared learning and the modernisation agenda.Commissioners and providers sometimes struggle at alocal level to make the necessary changes to dayservices, and there is very little in the way of expertsupport available to help them do this. Hands on supportin relation to both the modernisation process and thedevelopment of modernised services would bewelcomed and would help increase the chances ofeffective change happening. There is also a need forresearch into the new approaches to delivering dayservices to demonstrate their effectiveness andthe outcomes achieved.

The revised social inclusion outcome framework 27 andthe accompanying outcome measurement tool will givecommissioners and providers the opportunity to use andembed it within service specifications and contractsacross and beyond the range of mental health services.There is the potential for findings to be pooled andcompared to provide benchmarking data, but this wouldrequire the allocation of necessary resource.

Identification and assessment processes of parental andfamily support have improved and many innovativearrangements between services are being developed tohelp to ensure better access support for affectedfamilies. However, this is challenging, as working acrosssystems can be complex so we recommend that thisarea of policy remains a priority for future activity.

NSIP has worked across departmental boundaries topromote systems and practices through which peoplewith mental health problems can participate andcontribute equitably as active citizens to the civic life oftheir community. We have tried to do this by influencingthe development of policy beyond mental health so thatit connects appropriately back to it. As localisationand the empowerment of diverse communities become

more central to government policy, so the developmentof inclusion practice will need to reflect and informthat policy, promoting and connecting inclusivecommunities with scope for active citizenship andprogressive social networks.

To support the development of community engagementby participating Foundation Trusts, a certificate course inCommunity Engagement, Mental Health and SocialInclusion will be developed at UCLan for governors,members and relevant staff in Foundation Trusts who jointhe ‘Communities of Influence’ network.

11

5 Department of Health, 2006, From segregation to inclusion: Commissioningguidance on day services for people with mental health problems.

6 Department of Health, 2006, Supporting Women into the Mainstream:Commissioning Women-only Community Day Services.

7 Department of Health, 2008, From segregation to inclusion: where are we now?A review of progress towards the implementation of the mental health day servicescommissioning guidance.

8 NSIP, 2008, How will my newly redesigned day service help me?socialinclusion.org.uk/publications/DayServicesLeaflet.pdf

9 Ibid.

10 NSIP, 2007, Outcomes Framework for Mental Health Day Services.socialinclusion.org.uk/publications/DSdoccover.1.pdf)

11 NSIP, 2009, Outcomes Framework for Mental Health Services.www.socialinclusion.org.uk/home/index.php

12 Social Exclusion Unit, op. cit., 2004.

13 Department of Health, 2006, Direct payments for people with mental healthproblems: A guide to action.

14 Department of Health, 2006, An introduction to direct payments in mental healthservices: Information for people eligible to use mental health services and carers.

15 Ibid.

16 Commission for Social Care Inspectorate, 2009, The state of social care inEngland 2007–08.

17 Individual Budgets Evaluation Network (IBSEN), 2008, Evaluation of the IndividualBudgets Pilot Programme Final Report. The copyright is held by Social PolicyResearch Unit, University of York.

18 Social Exclusion Unit, op. cit., 2004.

19 Department of Health, 2008, Refocusing the Care Programme Approach: Policyand Positive Practice Guidance.

20 Cabinet Office, 2007, Reaching out: Think Family.

21 Barnardos, 2007, Parents in Hospital: How mental health services can best providefamily contact when a parent is in hospital.

22 Social Exclusion Unit op. cit., 2004.

23 Department for Transport, 2007, Concessionary Bus Travel Act 2007.

24 Department for Transport, 2008, Guidance for local authorities on eligibility fordisabled people.

25 www.governornet.co.uk

26 Leeds Partnership NHS Foundation Trust

27 NSIP, op. cit., 2009

VISION

Everybody should be helped to be the best they can and thosewho want, and are able, to work should receive the right supportto achieve their employment aspirations. Our vision is that:

� Employers are supported to feel confident in recruitingand retaining people with mental health problems andrecognise the commercial benefits of promoting mentallyhealthy workplaces.

� Employers have positive attitudes and high expectations ofwhat people can do, rather than focusing on what peoplecannot do.

� It is recognised that people with mental health problemsare just as capable as other employees and can effectivelycontribute to business objectives.

� Robust local mechanisms and partnerships supportindividuals to consider and prepare for work and improvetheir access to employment opportunities.

� Strong links exist between employment and bothvolunteering and learning and skills as important steps toobtaining and sustaining employment.

EMPLOYMENTCHAPTER 2 12

PROGRESS SINCE 2004

“Work helped me to piece my life back together again.” 28

Most people with mental health problems want to work 29

and with the right support, many more would be able toachieve their employment aspirations. There is strongevidence 30 to suggest that a job or another form ofoccupation is highly effective in improving wellbeingand social inclusion.

COMMISSIONING GUIDANCEIn response to the SEU report,31 NSIP has publishedcommissioning guidance on vocational services forpeople with severe mental health problems.32 It highlightshow important being in work is in both maintaining goodmental health and promoting the recovery and wellbeingof those who have experienced mental health problems.The guidance provides a framework on how tocommission evidence-based vocational services andhighlights tools for monitoring the effectiveness of suchservices. It also includes methods that successfullyaddress the employment needs of people with severemental health problems, one of which is the ‘IndividualPlacement and Support’ (IPS) model.

At a regional level, we have delivered a number ofworkshops on the commissioning guidance to a broadrange of practitioners working in employment and mentalhealth services. They focused on progress since theguidance was published, resolving tensions anddeveloping regional strategies to meet the vocationalneeds of people with mental health problems. Theworkshops stimulated the formation of local networkswhere improvement targets can be set and monitoredover time, and have helped staff to clarify local servicedelivery chains. This has led to improved employmentoutcomes, the development of local action plans and areallocation of resources into the employment agenda.

To further demonstrate how to develop effectivevocational services we have also published ‘Finding andKeeping Work’,33 to support positive employmentoutcomes for people with mental health problems.

DEVELOPING EMPLOYMENT POLICYNationally, NSIP has supported a number of strategicdevelopments on mental health and employment. Thisincludes supporting the Department of Health and theCabinet Office on development of the Public ServiceAgreement (PSA) 16, which sets out a direction of travelfor increasing the proportion of socially excluded adultsin settled accommodation and employment. The nationallevel indicator 150 34 is the proportion of adults incontact with secondary mental health services who arein employment. PSA 16 in relation to housing is alsodiscussed in Chapter 4.

NSIP has worked with government colleagues on theresponse to Dame Carol Black’s report ‘Working for ahealthier tomorrow’35 and supported the development ofthe National Mental Health and Employment Strategy 36

(due spring 2009). We have also helped to establish thecross-government group on mental health andemployment to which subsequently we have madesignificant contributions. Key aspects of this work involveeffecting cultural change on mental health andemployment, increasing awareness and take up ofavailable services and improving training for a broad rangeof intermediaries and organisations. To achieve this wehave developed several training resources, including onefor intermediaries on how to best work with employers onmental health problems, as well as resources for linemanagers and for trade union representatives.

REGIONAL EMPLOYMENT TEAMS (RETS)In 2006 the Cabinet Office published ‘Reaching Out:An Action Plan on Social Exclusion’37 which outlined thegovernment’s strategy for targeting effective help at themost excluded groups in society. Working through anNSIP secondee to the Prime Minister’s Strategy Unit,we supported development of action point 23,38 onimproving employment outcomes for people with severemental health problems through developing dedicatedregional employment teams (RETs) to promote goodpractice and have since been responsible forestablishing and leading these teams. These nine RETsover the ensuing two years, have formed partnershipsthat encourage a coordinated and coherent effort amongkey regional stakeholders such as Jobcentre Plus,Government Offices, Regional Development Agenciesand Learning and Skills Councils, as well as healthprofessionals and the voluntary sector. A significant

13

INDIVIDUAL PLACEMENT AND SUPPORTThe ‘Individual Placement and Support’ (IPS) model isbased on joining up services in order to deliver tailoredsupport. The approach involves assessing a person’svocational skills and preferences relatively quickly andthen placing them in employment settings that areconsistent with their abilities and interests and wherethey can develop their skills in the work environmentwhilst getting ongoing support. If needed, support isalso given to the employer and individual in theworkplace to ensure maintenance of the placement.

aspect of this effort has entailed working with localities toimprove employment outcomes with a particular focuson supporting the mental health employment target inPSA 16. To date, this has been effectively achieved;improved practice being promoted by more effectivejoined-up working between partners.

RETs have also supported local authorities to do more toadvance employment opportunities for people withmental health problems with a particular emphasis onthose districts that have adopted National Indicator 150.Activities undertaken by the regional partnershipsinclude:

� Working strategically within partnerships to raiseawareness of the need to deliver holistic services.

� Building capacity in health systems to deliverincreased employment opportunities.

� Supporting and promoting activity that allowsindividuals to increase capacity for obtaining andretaining employment, such as the development ofstructured volunteering arrangements.

� Working to reduce stigma and discrimination,especially in the workplace setting, such assupporting the expansion of Mindful Employer 39 andShift’s ‘Line Managers’ web resource’.40

� Promoting activity aimed at maintaining a mentallyhealthy workforce. This includes supporting theincrease in people being trained on Mental HealthFirst Aid 41 and supporting the expansion ofrecommended frameworks such as the Health andSafety Executive ‘Stress Management’ standards.42

In addition to exploring links between national policiesand regional and local actions to overcome barriers, theRETs have also looked at how best to influence existingand developing policies and strategies, such as the CityStrategy Initiative,43 the roll out of Pathways to Work andIncreasing Access to Psychological Therapies.44

EMPLOYERS

“A successful return to work following an episode ofmental illness is possible, but it has to be managed well– long-term recovery is not an accident. Good employerswill take ‘return to work’ practice seriously andencourage a staged and supportive – even protectedreturn to work. Part-time work, for a time can be awonderful investment for long-term good health.” 45

In addition to our high level strategic work onemployment, we have also been working closely to

support employers and raise awareness andunderstanding of mental health in the workplace bydeveloping and delivering, for example, a trainingpackage for trade union representatives. We haveestablished an Employer Engagement Network to sharethinking and best practice on how to support employersin the employment and retention of people with mentalhealth problems. The network has a membership ofmore than 60 organisations including a range ofgovernment departments, practitioners and academics.One output has been that of hosted workshops on keyand developing policy issues such as how best to adaptand make the ‘Access to Work’ programme more flexibleto help many more people with a mental health problemto remain at work.

The RET partnerships have also increased organisationalcapacity in the regions. They have supported the NHSand public sector organisations to become ‘ExemplarEmployers’ of people with mental health problems.This has encouraged PCTs and Mental Health Trusts toconsider greater volunteering and employment initiativeswithin their organisations, and enabled trusts to considerhow the Care Programme Approach (CPA) process andits outcome measurement tools can increase theproportion of people who wish to (re) gain employment.

TRAININGEnsuring that frontline staff are appropriately trained isfundamental to improving employment opportunities forpeople with mental health problems. NSIP has workedwith a wide range of stakeholders to develop a mentalhealth awareness training package for trade unionrepresentatives. The training package was piloted during2007/08, and was followed by the delivery of trainingevents across several regions. The training has beenembraced by a wide range of unions, including Unite,Public and Commercial Services (PCS), Prospect andUnison and has been delivered to more than100 representatives.

NSIP has also met with Jobcentre Plus on how toimprove the quality of their customer service and

CHAPTER 2 EMPLOYMENT 14

ROYAL MAILThe Royal Mail is the UK’s second largest employerafter the NHS. NSIP is working in partnership withRoyal Mail to promote the employment opportunitiesof people with mental health problems, to supporthealth-promoting initiatives within the workplace andin challenging discrimination.

employment support that people with mental healthproblems receive. This led to us working with JobcentrePlus training experts to develop a training module onmental health and employment awareness, which hasnow been formally adopted. We are also working tofinalise a training product for engaging and working withemployers on mental health problems.

INCOME, BENEFITS AND THE WELFARE SYSTEMSince 2004, NSIP has supported changes to theIncapacity Benefit linking rules so that returning to workand the claiming of benefits is more flexible andsupportive for people with mental health problems. Wehave also been instrumental in securing some positivechanges to the welfare benefits system.

NSIP has sought clarification of guidance for voluntarywork, which now makes it clear that individuals can bereimbursed for travel and meal expenses without itaffecting their entitlement to benefits.

We welcome Employment and Support Allowance as amove towards a simpler benefits system whichrecognises that some people need additional support. Italso encourages and supports those who can return towork to do so. The extension of the Permitted Workrules (PWRs) within Employment and Support Allowanceto apply equally to both income-based and contribution-based claimants enables more people to accessemployment at a pace that suits them.

NSIP’s position on PWRs has also challenged theinequality that exists for people on different types ofbenefits. We have set out what needs to be done withthe Department for Work and Pensions so that PWRsact as an enabler for people with mental health problemstrying to return to work.

REMAINING CHALLENGESOver the last few years there has been an increasingamount of health, employment and wider supportavailable to employers and people with disabilities, butdespite an overall improvement in the disability

employment rate, people with mental health problemshave not benefited as much as other groups. Specifically,there has been little change in the very low employmentlevels for people with more severe mental healthproblems.

Improving employment rates for people with mentalhealth problems requires progress on a number of fronts.Individuals may require more specialised and sustainedsupport to ensure that work becomes, or remains anachievable goal. This support should take into account arange of issues, such as low levels of skills orconfidence, debt, caring responsibilities and/or otherhousehold circumstances. In addition, the attitudes andperceptions of carers, health professionals and familiescan be unhelpful and stigma and discrimination is still animportant issue.

Underpinning many of these challenges is the need formore extensive research to develop the evidence base tobuild and promote a strong case for the employment ofpeople with mental health problems. This will ensure thatindividuals and employers can quickly access appropriatehelp and support whenever they need it. For services tobe more effective and better utilised, they should meet awide range of need, be joined-up, simple to access andshow the benefits of adopting best practice anddelivering tailored support. It is equally important topromote knowledge as to how providers can developeffective employment services and staff skills.

Concerns remain about Employment and SupportAllowance as it currently stands, in respect of thedisparity within the benefit for those who have previouslypaid contributions and those who have not. It isimportant that Employment and Support Allowancecontinues to be evaluated to ensure that it meets theneeds of those with mental health problems.

CONCLUSION AND PROPOSED FUTURE ACTIONWhilst Individual Placement and Support is an effectivestructured approach to securing sustainableemployment, we recognise that it does not always workfor everyone, and that for some work is not animmediate option. It will therefore be important toconsider what a suite of provision might contain andensure that appropriate systems and services are inplace in each area to meet the needs of individuals.

It is important to build upon the momentum created bythe RETs since this has provided a coordinatedapproach to secure better employment outcomes forpeople with severe and enduring mental health problemsand meet expectations of PSA 16.

15

BENEFITS DOWN-RATINGIn 2004, building on a lengthy existing campaign byDerbyshire Patients’ Council and Mind, we workedwith ministers and senior officials to highlight issuesconcerning the impact of benefit down-rating forpeople with long-term hospital stays. This resulted inthe end of ‘down-rating’, securing improvements inthe lives of 21,000 people, to the value of £60 million.

The need to deliver holistic support is even more criticalin the current economic downturn when the number ofpeople experiencing poor mental health is likely toincrease and when more people may become at risk oflong-term unemployment. The challenge will be todemonstrate how the national mental health andemployment strategy will help change attitudes,assist the development of an evidence base andpromote the creation of a comprehensive range ofmainstream and specialised information and supportwhich assists access to, and retention of, goodemployment opportunities.

CHAPTER 2 EMPLOYMENT 16

28 Department of Health, 2006, Action on Stigma: promoting mental health, endingdiscrimination at work.

29 Within the Patient Survey (Healthcare Commission, 2005), 52% of respondents saidthey had not received any help with finding work but would have liked it.

30 W Anthony, A Howell and KS Danley, ‘Vocational Rehabilitation of the PsychiatricallyDisabled’ in M Mirabi (ed.), The Chronically Mentally ill: Research and Services,(Jamaica/New York, Spectrum Publications, 1084); G Shepherd, ‘The Value of Workin the 1980s’, Psychiatric Bulletin, 13 (1989): 231–233.

31 Social Exclusion Unit, op. cit., 2004.

32 Department of Health/NSIP, 2006, Vocational services for people with severemental health problems: Commissioning guidance.

33 NSIP, 2008, Finding and Keeping Work.www.socialinclusion.org.uk/publications/Toward_a_MH_employment_strategy_revsied_after%20repairs.pdf

34 The national indicators are the means of measuring national priorities that havebeen agreed by government.

35 Dame Carol Black, 2008, Review of the health of Britain’s working age population.Working for a healthier tomorrow.

36 For the announcement of the development of the national mental health andemployment strategy see:www.dwp.gov.uk/mediacentre/pressreleases/2007/nov/drc057-271107.asp

37 Cabinet Office, op. cit., 2006.

38 Action 23 reads “Building on current guidance and legislation, the Government willdevelop dedicated regional teams to provide further support for the implementationof good practice around employment of those with severe mental health problems.”

39 The Mindful Employer initiative is aimed at increasing awareness of mentalhealth at work and providing support for businesses in recruiting and retaining staff.See website www.mindfulemployer.net/

40 See Shift’s line managers’ web resource site: www.shift.org.uk/employers/

41 www.mentalhealthfirstaid.csip.org.uk/

42 See the Health and Safety Executive stress website: www.hse.gov.uk/stress/index.htm

43 See Department for Work and Pensions’ announcement:www.dwp.gov.uk/welfarereform/cities_strategy.asp

44 For information on Increasing Access to Psychological Therapies see:www.iapt.nhs.uk/

45 Department of Health, op. cit., 2006

VISION

People with mental health problems, by accessing learning andskills provision, should be able to lead active and fulfilling livesas part of their communities and in employment, in a way thatsustains mental wellbeing. Our vision is that:

� Learners with mental health problems have equal accessto the full range and diversity of learning opportunities intheir area.

� Learners take a valued and active part in their education andprogress towards their goals in life and work.

� Collaboration and partnership working with key stakeholders,including learners with mental health problems, ensure thatholistic packages of provision meet learners’ learning, skills,employment and mental health needs.

CHAPTER 3 17

LEARNING AND SKILLS

PROGRESS SINCE 2004

“Adult learning has enabled me for the first time to havegoals that I know, with effort and work, I can achieve.” 46

We know that involvement in learning can often have apositive impact on a person’s mental health. In additionto acquiring new skills, learning can promote confidence,build resilience to stress and give people a greater senseof purpose. It enables people to meet other studentsand make new friends, and can lead to getting back intoemployment or finding a better job.

As employers demand and need an increasingly skilledworkforce, taking up opportunities to participate inlearning as a route to employment and learningopportunities at work is becoming more important,particularly at a time of economic downturn. Ensuring thatlearning and training opportunities support progression toemployment and prospects for getting on in theworkplace have been key elements of the work that NSIPcarries out through the learning and skills work stream.

There has been considerable progress since thepublication of the SEU report 47 in understanding thelearning needs of, and improving the levels of supportavailable to, people with mental health problems whowant to learn.

“This course has allowed me to get to grips with my newearly rises at 8am, my laundry, my shopping and mealarrangements, and begin to learn about the importanceof saving my money for a flat… I can still go on and do auniversity course. Only now I have a little more experienceof being in education again. I also have living skills.” 49

PARTNERSHIP PROGRAMMEA Partnership Programme between NSIP, the NationalInstitute of Adult Continuing Education (NIACE) and the

Learning and Skills Council (LSC) has allowed us tomake an impact on the Further Education system and tocreate a body of work that will have a positive effect onthe social inclusion of people with mental healthproblems and leave an enduring legacy.

An LSC Task Group has been set up to oversee andadvise on the work of the Partnership Programme whosemembership includes the Department for Children,Schools and Families; the Department for Innovation,Universities and Skills; the Department of Health and theDepartment for Work and Pensions; the Employers’Federation; learners with mental health problems and thevoluntary sector.

NSIP contributed to the 2008 follow up strategy ‘refresh’to the LSC’s 2006 ‘Improving services to people withmental health difficulties’.50 This provides a renewedvision promoting the social and economic inclusion ofpeople with mental health problems through improvedaccess to and success in learning and skills. The finalstrategy will be launched March 2009 and willincorporate an action plan to 2015 that will helpsafeguard the interests of learners.

The Partnership Programme has successfully changedthe climate of support for learners within the LSC. At anational and strategic level the programme hasconsistently advocated for learners with mental healthproblems and through it, we have also built the capacityof providers to better meet learners’ needs bydeveloping resources, good practice guides and aquarterly newsletter.

NSIP has developed learning resources to supportprogression into learning and work, such as the ‘ReallyUseful Book of Learning and Earning’.51 New proceduresand forums have been created to allow greaterinvolvement of learners with mental health problems inthe development of policy and practice for bettereducation and training provision. We have alsosuccessfully encouraged the LSC and other learningproviders to sign up to be ‘Mindful Employers’to support them in their role as an exemplar publicsector employer.

Regional Project Officers lead the regionalimplementation of the Partnership Programme, withgreat effect, resulting in major improvement in ourworking relationships with each regional LSC. Theseposts are crucial if we are to ensure national strategy isimplemented regionally, that it impacts on providers andconsolidates collaborative working with the RegionalEmployment Team leads.

CHAPTER 3 LEARNING AND SKILLS 18

CARE PROGRAMME APPROACH (CPA) SOCIALINCLUSION PROJECTIn the East Midlands, work funded by NSIP with supportfrom the Learning and Skills Council (LSC) led to abaseline being set for educational attainment for peopleon the enhanced Care Programme Approach (CPA) noteducated to level 2, which is often seen as the keyindicator for employers on employability. The research 48

highlighted the level of educational disadvantageexperienced by many people with mental healthproblems, and how this compounds the disadvantagesthat they already face in the labour market.

COLLABORATIVE WORKINGWe have undertaken a range of projects, including the ‘Isit for me?’ initiative, which is described in more detail inchapter 1. We have also encouraged better collaborativeworking between Early Intervention in Psychosis Servicesand Child and Adolescent Mental Health Services toensure that young people experiencing mental healthproblems are supported to remain in education, trainingand employment.

All of the work we carry out at national and regionallevel is informed by a co-productive process of sustaineddialogue between policy makers, practitionersand learners. Through the dissemination of informationand the sharing of good practice, policy informspractice but the voice of the practitioner and the learnerclearly informs policy across government and sectors.

REMAINING CHALLENGESThe continued drive within the Further Educationsystem towards targets on the number of learnersachieving qualifications of level 2 and above has led toa loss of the non-accredited and lower level courses inthe sector that have often been the first step intolearning for many people with mental healthproblems. Funding for adult education has also beenincreasingly directed towards work-based learning,yet low take up of these opportunities by people withmental health problems continues to be problematic.

The end of the LSC in 2010 as the primary funder of thisprogramme of work and the establishment of two newagencies to take its place presents many challenges inensuring the continuation of the work of the PartnershipProgramme.

CONCLUSION AND PROPOSED FUTURE ACTIONTo work towards our vision of learners with mental healthproblems leading fulfilling lives, we want to safeguardtheir interests within the structures of the LSC’s successororganisations. The LSC’s action plan should highlight theneed to manage that transition to the new agencies andto the new requirements placed on local government.

Within the action plan, the Partnership Programme willneed to continue to build on successes and, in particular,to drive further development of the work that has alreadybegun to improve learning and skills opportunities foryoung people, aim to inform the work of the IntegratedEmployment and Skills Service, carry out a review oflearning and skills within Forensic Services and SecureUnits, take a more proactive approach to being anexemplar employer and continue to develop the capacityof the learning and skills workforce.

19

46 NIACE/NSIP, 2008, The Really Useful Book of Learning and Earning.

47 Social Exclusion Unit, op. cit., 2004.

48 V Utting and C Law, 2008, East Midlands Care Programme Approach (CPA) SocialInclusion Project, Final Report, NIACE downloadable fromwww.niace.org.uk/mentalhealth/docs/EM/EM-CPA-project-final-report.pdf

49 Ibid

50 Learning and Skills Council, 2006, Improving Services for People with Mental HealthDifficulties.

51 NIACE/NSIP, op. cit., 2008.

‘FAST TRACK’ SCHEMEIn Portsmouth, the PCT’s Early Intervention Teamsecured funding from the LSC and developed apartnership with local colleges for a ‘fast track’scheme for clients into Further Education with someexcellent outcomes, such as ‘Back on Track’, aproject tailored to meet the vocational needs of youngpeople with mental health problems.

VISION

Stable and appropriate housing is important if people withmental health problems are to work and take part incommunity life. Being able to live independently is equallyimportant to creating a socially inclusive community.Our vision is that:

� People with mental health problems have a place to live thatprovides a sense of well-being, belonging and continuity.

� Effective joint working between specialist and mainstreamhousing, health and social care agencies improvesoutcomes.

� The barriers to flexible choice are removed.

� Reliance on specialist accommodation and services isreduced.

� Commissioning of services meet people’s needs in a holisticway and is effectively integrated.

HOUSINGCHAPTER 4 20

PROGRESS SINCE 2004

“We need our independence and we want support onlywhen we need it, but we still want to be safe and secure.” 52

Since the SEU report,53 NSIP has coordinatedimplementation of the action points on rent arrearsmanagement to reduce non-payment and evictions,leading to the publication of ‘Improving the effectivenessof rent arrears management’,54 and local authorityallocations schemes which resulted in ‘Implementing andDeveloping Choice Based Lettings: A guide to key issues’.55

Following on from these, we produced mental health-specific briefing documents for housing, health andsocial care staff on rent arrears management 56 andChoice Based Lettings 57 to encourage better jointworking between services and increase support forpeople with mental health problems to improve theirhousing situation. This has helped prevent evictions andimprove opportunities to achieve independent living.

NSIP has also coordinated the SEU report’s actions onhomelessness. This includes the revision of the Code ofGuidance for local authorities which set out reviseddefinitions of those in priority need of housing.58 We alsoworked with the NIMHE/CSIP regional developmentcentres on a series of events to engage staff and peopleusing local homelessness services in the researchprocess to inform the development of ‘Getting Through:Access to mental health services for people who arehomeless or living in temporary or insecureaccommodation: A good practice guide’.59

To help drive progress forward, NSIP has broughttogether key government departments, housingagencies and stakeholders into a national HousingReference Group. The group’s role has shifted on fromadvising on the production of guidance documents tobecoming a flexible resource, consulting anddisseminating information on new policy and emergingpractice. As a result, we have been able to respondrapidly to and advise on any new housing and mentalhealth developments or initiatives.

NSIP is committed to ensuring that people with mentalhealth problems using housing services are listened towhen developing local and national policy. For example,we have coordinated a series of consultation events,working on behalf of, and across health policy areas togather the views of the wide range of people usingservices funded by the Supporting People programme,including people with mental health problems, and tofeed them into the development of the SupportingPeople national strategy.60

We have contributed to the joint Communities and LocalGovernment and Department of Health ‘Housing LearningImprovement Network (LIN) guidance’ on mental healthassessments of those who are homeless or insecurelyhoused.61 We have also worked on other Housing LINinitiatives, such as the current review of the Turnbull rulingon Housing Benefit eligibility, the growing role of ‘extracarehousing’, and a study of the experiences of people withmental health problems who have been homeless.

Recognising the importance of the Care ProgrammeApproach (CPA) as a vehicle for promoting socialinclusion within secondary services care and supportplanning, NSIP has contributed to the housing sectionwithin the revised CPA guidance,62 helping to raise theprofile of homelessness and non-secure housing aspriority issues for new CPA allocation.

One of the most significant developments concerninghousing and mental health since the creation ofSupporting People has been the new Public ServiceAgreement (PSA) 16 to increase the proportion ofsocially excluded adults in settled accommodation andemployment. NSIP has provided expert advice to theCabinet Office on both housing and mental health but

21

MENTAL HEALTH AND LIAISON OFFICERTelford PCT and the local authority mental healthservice jointly fund a post for a Mental Health andHousing Liaison Officer, whose brief has been tofoster understanding and co-working between thesetwo sectors at local level. Key activities includecoordinating a mental health and housing referralpanel that has highlighted unmet need, providingadvice to frontline staff, developing a training packagefor both sectors, and organising two annualconferences to enhance information sharing andnetworking between local agencies.

NETWORK FOR CHANGENetwork for Change, a voluntary sector mental healthsupport service in Leicester, is coordinating anaction learning set that brings together specialistmental health housing workers and localhomelessness and housing resettlement staff with theaim of increasing awareness of mental health and toimprove communications between staff in the relatedagencies. It has demonstrated how to enhancerecognition of mental health issues and how to buildnetworks and relationships.

also on wider social inclusion issues. We have sinceworked with the Cabinet Office, Communities and LocalGovernment and the Department of Health to secureagreement on the approach to PSA implementation andcontinue to provide high level input to the regional rollout. This has been done by raising awareness andsecuring engagement with regional Government Officesand the Cabinet Office. The NSIP Reference Group(consisting of people with mental health problems andcarers) has also made an invaluable contribution to thePSA development and delivery process. Chapter 6explains the role of the Reference Group in more detail.

REMAINING CHALLENGESAlthough considerable progress has been made, wehave identified a number of potential challenges that willneed to be addressed. The SEU report called formainstreaming of mental health awareness training forall housing staff but this has still not been achieved.We would recommend that all new and existing staffreceive mental health awareness training to enable themto respond to people in a supportive and flexible way.

Improved communications are often needed betweenthose working in housing and mental health services tohelp support people with severe and enduring mentalhealth problems with independent living. However, PSA16 should raise awareness of the need for cooperationand local performance framework structures, especiallythe Joint Strategic Needs Assessment, to identify unmetneed and less effective coordination of services.

Both the PSA and the CPA guidance stress the need foreffective and proactive work with those in secondarycare who are, or who become, homeless. Yet there isalso work to be done on how to meet the mental healthneeds of homeless people who are not in contact withsecondary mental health care. Here, new approachesmay be needed, and Practice-Based Commissioning viaprimary care could be equally or more suitable.

Greater pooling of resources at a local level will helpmake sure that services respond flexibly to the needs oftheir local communities and the development of sharedlocal priorities. However the removal of the ‘ring fence’for the Supporting People grant presents risks tolocal services and commissioning, such as resulting infunding being diverted away from providing muchneeded supported housing for people with mentalhealth problems.

Major restructuring of the housing regulatory and fundingframeworks took place in December 2008 and thecreation of entirely new organisations such as the Homes

and Communities Agency and the Tenant ServicesAuthority could bring a risk of the loss of thecommitment to housing for the most at risk groups.

Certain challenges remain which may act as barriers tothe inclusion of people with mental health problems inmainstream communities. For example most people withmental health problems live in their own homes, butthose with higher support needs may still beinappropriately living in residential care. Similarly, a lack ofsuitable move-on accommodation can result in extendedstays in hospital. Also people with mental healthproblems report that they are likely to be allocated lessdesirable properties and neighbourhoods, than thegeneral population.

With greater local accountability for all services, includingsocial housing, it is important that people with mentalhealth problems and carers, and mental health servicesengage in these local debates on the housing thatpeople need.

CONCLUSION AND PROPOSED FUTURE ACTIONCommissioning and system change will require visionand local leadership. We believe such a vision comes notjust from managers and commissioners but also frontlinestaff, carers and people using services themselves.

Housing has become an increasing focus of concern formental health services and the work of NSIP has beeninstrumental in converting generalised concern into a setof achievable actions. With the impetus provided first bythe Public Service Agreements and also by new work oninequalities, public health and the social determinants ofhealth, we are confident that this work agenda has asolid foundation and will continue to progress.

CHAPTER 4 HOUSING 22

52 Telecare Services Association, 2008, Telecare and Telehealth –Centres of Excellence

53 Social Exclusion Unit op. cit., 2004.

54 Office of the Deputy Prime Minister, 2005, Improving the Effectiveness of RentArrears Management: Good Practice Guidance.

55 Office of The Deputy Prime Minister, 2005, Implementing and Developing ChoiceBased Lettings: A guide to key issues.

56 NSIP, 2006, Improving the Effectiveness of Rent Arrears Management for Peoplewith Mental Health Problems.www.socialinclusion.org.uk/publications/Rentarrearsbriefing.pdf

57 NSIP, 2006, Choice Based Lettings for People with Mental Health ProblemsA Briefing Guide. www.socialinclusion.org.uk/publications/NSIP_CBL_briefing.pdf

58 Communities and Local Government, 2006, Code of Guidance for Local Authorities.

59 NSIP, Department for Health, Communities and Local Government, 2007,Getting Through: Access to mental health services for people who are homeless orliving in temporary or insecure accommodation: A good practice guide.

60 Communities and Local Government, 2007, Independence and Opportunity –Our Strategy for Supporting People.

61 Communities and Local Government/CSIP Housing Learning and ImprovementNetwork, 2008, Housing LIN Briefing: Understanding Homelessness and Mental Health.

62 Department of Health, op. cit., 2008.

VISION

Arts, cultural engagement and community participation arefundamental to the development of socially inclusive society.People with mental health problems should have access to thesame diverse range of arts and cultural activity as others inthe places where they live. Our vision is that:

� The role that arts and culture play in improving wellbeing, healthoutcomes and personal identity is recognised and resourced.

� Community and large-scale arts organisations will workwith and alongside people with mental health problems,to understand how to remove barriers, be accessible andreduce stigma.

� The use of arts and culture raises awareness of mental healthproblems and supports the challenge against stigma anddiscrimination.

CHAPTER 5 23

ARTS AND CULTURE

PROGRESS SINCE 2004Arts and culture include all creative activity whetherengaging by seeing, listening or taking part. Participationin the arts can give people a positive alternative identityto that of ‘service user’ and help people be part of thewider community by increasing self-esteem, confidenceand social networks.

Arts and culture also play an important role in health andhealthcare provision. They help deliver real andmeasurable benefits across a wide range of priority areasfor health and can enable the Department of Health andthe NHS to contribute to key government initiatives.Strong leadership through promotion, development andsupport, is required to create an environment in whichpeople with mental health problems can prosper throughtheir involvement in arts and health.

The SEU report 63 highlighted the need for research tounderstand improvements in health and social outcomesas a result of participation in arts projects. In response tothis, ‘Mental health, social inclusion and arts: developingthe evidence base’64 was published. It found that:

� There were significant improvements inempowerment, mental health and social inclusion.

� There was a significant decrease in the proportion ofparticipants identified as frequent or regular users ofservices.

� The improvement in empowerment and mental healthamongst people with more severe issues at baselineindicates that arts projects can benefit people with arange of mental health needs, including those withmore significant problems.

“When I am painting I forget everything else. Realisingthat I can develop my artistic skills I feel proud of whatI have achieved and it has done wonders for myself-esteem.” 65

In response to these findings, NSIP successfullyestablished a working partnership with The WallaceCollection, the Museums, Libraries and Archives Council,Tate Modern, Portugal Prints and the V&A. Museumsand galleries can address social exclusion not only byencouraging participation in the arts, but also byconnecting people with experience of mental healthissues to the wider community, and by promoting accessto training, volunteering and employment opportunities.

‘Open to All’, a training package launched by the HealthSecretary at a joint NSIP event at The Wallace Collectionin September 2008, is designed to encourage museums

and galleries to involve people with experience of mentalhealth problems, thereby helping to build the necessarybridges to museums and galleries and the widercommunity. Commissioned by the partnership, it wasdeveloped by the University of Nottingham, NottinghamCounty Teaching PCT and the Lost Artists Club and willbe available for staff in museums, libraries and galleriesat a local level throughout the country, frommid 2009 onwards.

NSIP has also widened its arts focus to includeparticipatory arts, such as theatre, dance and music.A range of innovative practice is underway through ourpartnership working with the Arts Council (England)and each of the Arts Council Regions, NIMHE/CSIPregional development centres, theatres and communityarts organisations and practitioners.

We have established a national arts evaluation advisorygroup with membership from arts practitioners, artstherapists, academics, people with mental healthproblems, health practitioners and commissioners aspart of its work stream on evidence and innovation. Thegroup has developed evaluation guidance and supportfor arts organisations and practitioners which will bothadd to the evidence base and help organisations whowant to commission arts and cultural initiatives. Thisguidance will be published spring 2009.

Work is also underway in both the North West andSouth West, where arts organisations are working inco-production with health and social care partners tocreate healthy, sustainable communities. The SouthWest work will be launched in May 2009 with aconference in Dartington.

CHAPTER 5 ARTS AND CULTURE 24

THEATRES SOCIAL INCLUSION PARTNERSHIPA group of London-based theatres including theRoyal Court, Roundhouse, National, Southbank,Half Moon and Tricycle are working in partnershipwith NSIP and the Arts Council to become leaders insocial inclusion. They are developing ways to includesocial inclusion issues through their local communitiesand policies. A seminar held in November 2008 washosted by the Roundhouse in order to celebrate thisunique partnership, widen the debate and to explorefurther opportunities. Ongoing work will include thecoordination of web-based and real discussiongroups to pool experiences, ask questions and definegoals for a co-produced programme.

NSIP has carried out a review of regional and local arts inhealth programmes in order to develop and buildregionally focused networks. These bring together NSIPsocial inclusion leads, service improvement leads, artspractitioners, voluntary and community artsorganisations, academic institutions and arts councilregional leads and links these to a pan-Europeannetwork of arts, inclusion and wellbeing in practice.

REMAINING CHALLENGESThere is a risk that arts and culture activity is not givenenough attention within a landscape of public serviceagreements and local area agreements. Projects areoften funded for time-limited periods, which can makeevaluation and continuity difficult.

CONCLUSION AND PROPOSED FUTURE ACTIONNSIP has worked with a range of key stakeholders toensure that arts and culture in relation to mental healthand social inclusion retains a high profile within the widerpolicy agenda.

We would like to see more partnership working acrosscentral and national structures as the complex nature ofthis work demands a more co-productive approach inthe future. There is greater scope for the Department ofHealth, Department for Culture, Media and Sport andDepartment for Innovation, Universities and Skills tofocus on arts and cultural development together,enabling more innovative and creative activity.

NSIP is working in partnership with the CulturalOlympiad 66 to ensure the social inclusion of peoplewith mental health problems. We are working inpartnership with the South West Cultural Olympiad andare part of the advisory group on local cultural activity.This work is in its very early stages and it is envisagedthat it will be developed alongside other localities inpreparation for 2012.

NSIP is working in partnership with the London Arts inHealth Forum to establish a network of key organisationsto coordinate activity in arts and wellbeing. We havesupported the development of evaluation guidanceleading to an accessible evidence base.

The publication of the Arts Council and Department ofHealth joint prospectus on arts in health in 2007 hasseen the beginnings of positive development in the artsand health sector. This work should be built upon toensure that it addresses the inclusion needs of peoplewith mental health problems.

25

63 Social Exclusion Unit, op. cit., 2004.

64 Anglia Ruskin/UCLan Research Team, 2007, Mental Health, Social Inclusion andArts.

65 Ibid.

66 london2012.com/get-involved/cultural-olympiad/index.php

SING YOUR HEART OUT (SYHO)Singing workshops are run by a professional voicecoach in Norfolk, for people who use mental healthservices, friends, family, support workers and staff.

In 2008, NSIP commissioned an evaluation of thesocially inclusive benefits of the workshops. Itsevaluation looked at the way in which SYHOprovided:

� An opportunity for individuals to develop skills andresilience that support their recovery and socialinclusion.

� A bridge to connect with socially inclusiveopportunities within the local community.

� A vehicle to tackle the stigma, discrimination andinequalities encountered by people whoexperience mental health problems.

The evaluation established significant evidencethat SYHO has provided a great opportunity forindividuals to develop a range of singing and choralskills. These skills, together with a supportiveenvironment have encouraged the development ofvarying degrees of interpersonal skills. Socialinteraction has enabled a sense of inclusion andimpacted positively on the recovery of those involved.www.socialinclusion.org.uk

VISION

Strong leadership and a skilled, effective workforce are bothessential in setting the direction that makes a positivedifference to the lives of people with mental health problems.Our vision is that:

� Commissioning for socially inclusive outcomes drives thecommissioning of all services.

� Corporate and strategic sign up to social inclusion shapesservice delivery.

� Social Inclusion is an integral part of professionalpre-registration training and continuous professionaldevelopment (CPD).

� People with mental health problems and their carers leadthe development and promotion of socially inclusive serviceswith staff and organisations.

LEADERSHIP ANDWORKFORCEDEVELOPMENT

CHAPTER 6 26

PROGRESS SINCE 2004NSIP has supported projects at both local and nationallevel that reflect the importance of leadership andworkforce development throughout the NHS and itsprovider organisations, services and staff. We have alsoactively developed a close relationship with a number ofprofessional bodies of staff working in mental healthservices which has had a positive impact on boththe national strategy and guidance that they provide.It has also given us a direct route to clinicians andpractitioners, and to influencing practice on the ground.

DELIVERING EFFECTIVE LOCAL LEADERSHIP FORSOCIAL INCLUSION (DELLSI)The aim of the DELLSI initiative has been to facilitate thebringing together of leadership development andservice improvement at a local level to promote socialinclusion. To achieve this, three NHS Trusts 67 wererecruited through the Mental Health Network of theNHS Confederation and these took part in theprogramme between September 2006 and May 2008.Key features included:

� Developing the position of participating organisationswithin their local communities and supportingtheir work in promoting the social inclusion of peopleusing their services.

� Focusing on outcomes of agreed local importance.

� Exposing and promoting the positive core ofthe participating organisations and the individualswithin them.

� Using assessment tools and research-basedapproaches to strengthen team working amongsenior leaders and managers within and across localorganisations to promote effective partnerships.

A Development and Delivery Team (DDT) wasestablished with support from NIMHE to oversee theinitiative and coordinate the work. Working with localstaff to help build capacity and sustainability,‘learning and exchange events’ were held where teamsfrom the three Trusts came together in a supportiveatmosphere to share experiences. Bespoke initiativeswere developed covering issues such as governors’awareness of and involvement in social inclusionwork as part of the establishment of a Foundation Trust,building relationships with local resources for leisure(based on the assessed need and involvement ofpeople using services), engaging with community leadersand developing care planning processes to be moresocially inclusive.

Lessons learned included:

� The importance of adding value at a strategic level byalignment with organisational priorities, whilst avoidingreliance on a top-down directive approach to motivateparticipation.

� The need to ground plans in a systematic assessmentof what people using services say they want andneed.

� Building from participants’ own understanding andevaluations of social inclusion locally.

� Taking a team approach, so that different groups andindividuals pursue their issues of concern and buildfrom their strengths.

� Maintaining a ‘can-do’ approach and remaininghopeful even in the face of resistance, apathy orevents not going as planned.

� Using senior stakeholders to broker relationships onbehalf of the team.

� Engaging people who use services to communicatethe project messages throughout the organisation.

� Being realistic about the time frame needed toachieve improvement and consciously promotingsustainability from the outset.

The DELLSI initiative has been positively evaluatedand work is underway with new partners to develop asecond phase with twice the number of sites.

EXPERT ADVISORS AND REFERENCE GROUP

“There is no doubt that we have set a high andsuccessful standard for service user involvement andthis is probably one of our greatest achievements.” 68

NSIP has always recognised the importance ofmeaningful involvement and participation of people withmental health problems and carers to co-producing ourwork. We have been working since 2006 with fourExpert Advisors, recruited from the existing Shift Boardof Advisors. Helping to forge stronger links across thetwo programmes, participating on recruitment panelsand in the active measurement of good practice in arange of service settings, contributing to thedevelopment of key resources such as our website,evaluation tenders and publications; the impact andcontribution of our advisors has been enormous.

In addition, they have contributed to the public profile ofinclusion work by playing an integral part in the planning,organisation and delivery of NSIP hosted events, most

27

notably at a key conference held at Charlton AthleticFootball Club in 2008, and presenting at these events ona range of issues. They have also supported thedevelopment of the Reference Group.

“Being at the cutting edge of a new form of userinvolvement, where involvement is no longer theappropriate word, because that puts the onus onthe professionals. Cooperation in its literal sense ofworking together.” 69

The Reference Group, with its 15 formally appointedmembers, started life in 2005, initially to work specificallyon the employment and benefits issues within theprogramme. However, such is the collective contributionof the group that its perspective has been broadened tocover the entirety of our work, offering NSIP a practicalmeans of integrating its strategic work with individualexperience.

The Reference Group also provides regional progressupdates to the national team and feedback on nationalprogress to the regional groups; a way of gathering localinformation and inputting to national policy andconsultations to empower people to influence theservices they receive. Group members reflect thenational context of the work undertaken by NSIP both interms of the rich variety of interests and geographicspread that they represent.

The group has contributed to a number of importantpieces of work including:

i Meeting with government officials to feed in theperspectives of people with mental health problemson a range of policy, such as:

� HM Treasury’s review of mental healthprogrammes.

� The operation by the Department for Work andPensions of Disability Living Allowance.

� The Department for Work and Pensions’ DisabilityStandards booklet ‘Help if you are ill ordisabled’,70 proposing suggestions for the wayforward for improving customer services.

ii Working with ministers and senior officials tohighlight issues surrounding the impact of benefitdown-rating for people with long-term hospital stays,securing £60 million in benefits.

iii Providing briefing for Department for Work andPensions’ ministers on the operation of the benefitsystem and employment programmes and inputting

to a departmental position paper on Permitted Work,to ensure inclusion in the roll out of the PublicService Agreement 16 targets.

iv Feeding into the roll out by Jobcentre Plus ofEmployment and Support Allowance.

v Taking part in the consultation on the IndependentLiving Strategy by the Office for Disability Issues.71

vi Directly feeding into the consultation on futureservice provision of the Learning and SkillsCouncil.

vii Contributing to the Royal College of Psychiatrists’book on socially inclusive psychiatry, due to bepublished late 2009.

viii Working alongside a community engagementspecialist conducting site visits as part of the‘Communities of Influence’ project.

COMMISSIONING NETWORKNSIP has contributed to a number of regional initiativesaimed at supporting commissioners. In response todemand from mental health commissioners, andparticularly those with joint commissioningresponsibilities, we established a commissioningnetwork for social inclusion in early 2008. As well as thenetwork meetings with workshops held in London andthe East Midlands, a considerable amount of activity isself-generated by commissioners, who share ideas andrequests with each other. There have been continuedclose links with the day services programme andnetwork members have requested the production ofbroader socially inclusive outcomes guidance forcommissioners and providers,72 adapted from the dayservices framework.73 This network is ready fordevelopment and will need to find a new host in 2009.

NSIP has supported the embedding of inclusiveoutcomes into ‘World Class Commissioning’ whichneeds to be delivered within a social as well as clinicalframework, and which will be a key driver for deliveryorganisations. If commissioning is to ‘add years to lifeand life to years’ 74 then socially inclusive outcomes willneed to be pivotal in shaping this agenda. Whilst thestatutory responsibility for implementing the socialinclusion agenda lies with local authorities andPCTs, it has often been mental health services thathave championed action, with many appointing socialinclusion leads and staff. Partnerships betweenall the local players, including third sector organisations,are essential.

CHAPTER 6 LEADERSHIP AND WORKFORCE DEVELOPMENT 28

ACADEMIC AFFILIATESThe Collaborative Academic Network is a co-designedlearning network, led and coordinated by theUniversity of Central Lancashire (UCLan). Its memberswork together to advance practical and relevantcommissioned research and developmental work onsocial inclusion in mental health and to facilitate thespread of inclusive learning into practice and evidence.The network’s key tasks are to:

� Collaborate to clarify a set of metrics that can be usedby commissioners and regulators to assess theeffectiveness of mental health social inclusion work ata local level.

� Develop a community of practitioners and researcherswho actively link research into practice and vice versa,in order to enhance social inclusion in mental health.

� Develop and disseminate evidence-based practice toinform every level of the mental health system.

Many members of the Academic Network were formerlypart of NSIP’s earlier Research and Evidence Coalition.This coordinated and supported a range of researchinitiatives on inclusion and mental health, some of whichattracted significant funding and profile both nationallyand internationally.75 For more information please seeAnnex A.

In 2007/08, NSIP produced a data report for each of theregional employment teams (RETs). The reports drew onexisting national data sources, as far as possiblebreaking down data to a local level and exploring trendsover a three-year period (2005–2007) in relation toemployment, benefits and education issues for peoplewith severe mental health problems. The reportsprovided each team with information and analysis theycould use as a starting point in discussions with serviceproviders, commissioners and other partners to informthe targeting of their interventions. Backgroundinformation was included on the data sources, includingcommentary on the data quality and any limitations ofthe data sets.

Ongoing challenges in relation to this work are:

� Variations between data sources in their definition andclassification of mental health problems, in thepopulations they cover and the frequency of datacollection.

� The extent to which national data can be reliablydisaggregated to provide locally relevant information.

� The need for expertise and continuity of approach toreproduce any of the analysis to monitor progressover time and the resource implications that thiswould have.

� The lack of clarity about what is realistic to expect interms of progress and the extent to which changescan be attributed to national policies and initiatives.

PROFESSIONAL NETWORKSWorkforces need to have the right professional andleadership skills if they are to reflect the emergingdemands of delivering socially inclusive practice. NSIPhas supported putting strategic and professional levelstructures in place to ensure that appropriatedevelopment takes place and that frontline workers getthe right support at the right time.

The SEU report 76 referenced the barrier to inclusionconstituted by low expectations and negativeassumptions by frontline staff about the capabilities ofpeople with mental health problems. In order to challengethese perceptions and improve the experience of peopleusing services, NSIP commissioned the identification ofsocially inclusive ways of working, using the framework ofthe ‘The 10 Essential Shared Capabilities’ (ESCs) 77 toallow staff to reflect on their practice.

The Royal College of Nursing (RCN), the College ofOccupational Therapists (COT), the British PsychologicalSociety (BPS), the Royal College of Psychiatrists (RCP)and the Social Care Institute for Excellence (SCIE) fieldedrepresentatives to a working group which led to thepublication of the ‘Capabilities for Inclusive Practice’.78

This provided a mapping of individual capabilities to the‘Knowledge and Skills Framework’ 79 and organisationalcapabilities as described by the Healthcare Commissionin ‘Standards for Better Health’.80 The professionalbodies have continued to show strong commitment tothe social inclusion agenda. Good practice examplesinclude:

� Publication by the BPS of ‘Socially InclusivePractice’81 and supporting the secondment of aclinical psychologist into the NSIP team. The BPS hasalso established a Social Inclusion Steering Groupwith work streams on Children and Families,Offenders in prison and Return to work.

� A two-year secondment of an occupational therapistinto NSIP, funded by the COT, and publication of amental health strategy document ‘RecoveringOrdinary Lives’82 influenced by the NSIP agenda. Alsoa joint publication of ‘Work Matters’,83 a guide to

29

employment for occupational therapists in mentalhealth services.

� A Social Inclusion sub group hosted by the RCP,currently working on a publication to help define anddevelop the role of psychiatry in relation to socialinclusion.

� A joint SCIE and NSIP symposium to support the re-engagement of social care staff with social inclusionas a legitimate part of the social work role.

� A multi-disciplinary event in early 2009 hosted by theRCN with NSIP to showcase policy and practicedevelopments in social inclusion and equality,providing a means of formally consolidating thecommitment of all the professional colleges to includesocially inclusive oriented practice and associatedskills development.

All of these professional bodies are looking to influencethe incorporation of socially inclusive practice as part ofboth their undergraduate curricula and continuingprofessional development (CPD). However, this remainsa challenge; while the professional bodies have activelyengaged with NSIP during its lifetime, they may havemany competing agendas to meet. Promoting socialinclusion for socially inclusive practice could depend onindividual colleagues who have contributed to this workcontinuing to be in a strong position to take this forwardwithin their own organisations.

STAFF DEVELOPMENTIn order to make the capabilities clearly applicable in theworkplace for staff, NSIP commissioned the developmentof two measurement tools. The first 84 measures staffcapabilities and was developed by South EssexPartnership NHS Foundation Trust, and the second,developed by people using the services of ‘2gether’ NHSFoundation Trust, is a user and carer-led evaluation tool(due for publication spring 2009) that assesses sociallyinclusive practice within organisations and LocalImplementation Teams.

If we are to see the potential of these tools realised andembedded in changing staff and organisational practice,their greater promotion, dissemination and uptake willneed to be secured. This will be a key challenge wherethe current national network of regional developmentcentre-based social inclusion leads will no longer exist. Itmay be that both the academic network and professionalbodies and their networks will be able to ensure thatthese tools are accessed by practitioners in the future.

‘COMMUNITIES OF INFLUENCE’In engaging trusts across England in the ‘Communitiesof Influence’ project we are linked directly to 14 large-scale organisations and their workforces. While theproject focuses on members and governors being key toengaging with their local communities, the Trusts havealso identified their staff as being an importantcommunity to work with. ‘Communities of Influence’ isdescribed in more detail in Chapter 1.

It is of vital importance that corporate values and actionsreflect inclusion at strategic and operational levels.While many mental health and care trusts include socialinclusion in their organisational vision and values,regular revisiting of how this is done needs to take placeat corporate, service and team levels to ensure thatorganisations are meeting their objectives.

VOLUNTARY SECTOR CAPACITY BUILDINGAt a regional level, NSIP has worked with the MentalHealth Foundation in delivering a section 64 86 fundedproject with the voluntary sector in Northamptonshire.Using ‘Capabilities for Inclusive Practice’ 87 as theframework, workshops were provided with the aim ofincreasing voluntary sector capacity and capabilityin this area. A further outcome has been thedevelopment of an intensive two-day training programmefor staff. A one-day intensive training session for trusteesis currently in development.

CONCLUSION AND PROPOSED FUTURE ACTIONFurther work is required to achieve our ambitious goals.Practitioners promoting socially inclusive practice canonly be effective if the services or organisations that theywork in also promote inclusive working. There isoutstanding work to be done on the tariff or value to beplaced on achieving socially inclusive outcomesin the context of the new model NHS Mental Health(NHSMH) contract. It is believed this may link helpfully toquality premiums and/or Patient Reported OutcomeMeasures (PROMS).

Commissioning is still not always informed by the socialinclusion agenda. It can sometimes focus too much on

CHAPTER 6 LEADERSHIP AND WORKFORCE DEVELOPMENT 30

MEASURING INCLUSIVE PRACTICESussex Partnership Mental Health Foundation Trusthas independently used the ‘Capabilities for InclusivePractice’ to develop a tool for measuring inclusiveteam practice,85 and is now sharing this with a localauthority housing service to promote good practiceacross agencies.

the clinical aspects of mental health and too little onwider outcomes. Integrating commissioning for socialinclusion into ‘World Class Commissioning’,88 withinclusion outcomes identified as driving service deliveryneeds to remain a priority.

At a local level, our work has helped us to identify anumber of key learning points about what is needed tosupport effective local leadership for social inclusion inthe future. These include:

� The need to have senior sponsorship and interest.

� Looking at how to align objectives with organisationalpriorities.

� Ensuring that strong local ownership exists atteam level.

� Embedding socially inclusive outcomes inassessments of what local people say they want andneed and engaging with a range of stakeholders andpartners at the earliest stage.

� The importance of linking into national developmentsto add profile to local projects and promote learningand innovation.

31

67 The three Trusts are Kent, Leeds and West London.

68 NSIP Expert Advisor.

69 NSIP Expert Advisor.

70 See following link:www.jobcentreplus.gov.uk/jcp/stellent/groups/jcp/documents/websitecontent/dev_015974.pdf

71 Office for Disability Issues, 2008, Independent Living – A cross-government strategyabout independent living for disabled people.

72 NSIP op. cit., 2009.

73 NSIP op. cit., 2007.

74 Department of Health, 2007a, World Class Commissioning: Vision.

75 As exemplified by the work of Professor Peter Huxley et al in developing, with NSIP,a framework of inclusion measures.

76 Social Exclusion Unit, op. cit., 2004.

77 Department of Health, 2004, The 10 Essential Shared Capabilities – A Frameworkfor the whole of the Mental Health Workforce.

78 Department of Health, 2007, Capabilities for Inclusive Practice.

79 Department of Health, 2004, NHS Knowledge and Skills Framework.

80 Department of Health, 2007, Standards for Better Health.

81 British Psychological Society, 2008, Socially Inclusive Practice.

82 College of Occupational Therapists, 2006, Recovering Ordinary Lives: The strategyfor occupational therapy in mental health services 2007-2017 literature review.

83 College of Occupational Therapists, 2007, Work Matters: Vocational Navigation forOccupational Therapy Staff.

84 South Essex Partnership NHS Foundation Trust, 2008, www.socialinclusion.org.uk

85 Will be available on www.socialinclusion.org.uk

86 Now known as Third Sector Innovation and Excellence in Service Delivery Fund.

87 Department of Health, op. cit., 2007.

88 Department of Health, op. cit., 2007a.

VISION

� Mental health services support both individuals andcommunity organisations.

� Community organisations are flexible enough to allow peoplewith mental health problems to make a contribution.

� Policy makers, funders and regulators build expectationsand ensure that people with mental health problems areinvolved at all levels.

SOCIALLY INCLUSIVEPRACTICE:THE CAPABLE ORGANISATION AND TRANSFERABILITYOF OUR WORK

CHAPTER 7 32

Whilst NSIP’s work has focused on the specificexperiences of people with mental health problems,this work should not be entirely separated from thecircumstances of other people who experienceexclusion. This chapter considers the potential forapplying lessons learned in the mental health sphere toother efforts to combat social exclusion.

MENTAL HEALTH SERVICESAs we set out in ‘Capabilities for Inclusive Practice’,89

both individual and organisational capabilities arerequired if socially inclusive practice is to be embeddedand sustained.

Individual capabilities include:

� A commitment to understand and combat the barriersthrough which exclusion has a long-term and damagingimpact on an individual and their community.

� The ability to build positive, hope-filled relationshipswith those who have mental health problems thatfocus on recovery and inclusion by appropriatelyaddressing mental health problems in the context ofthe person’s wider ambitions.

� The ability to build positive relationships withcommunity organisations that open up newopportunities for participation and that challengeinstances of discrimination.

� The skills in matching the person with the rightcommunity activity (such as a job, training or leisureactivity), negotiating opportunities and adjustments,monitoring progress and helping to repair things ifthey are at risk of breaking down.

Organisational capabilities include:

� Prioritising a public commitment to social inclusion.

� Universal and specialist training programmes.

� Sufficient resources invested in building andmaintaining alliances with key communityorganisations.

� Effective monitoring arrangements that examine theservice outcomes (gaining a job, home or newrelationship) and the activities which lead to theseoutcomes.

As already discussed, NSIP has worked to embed thesecapabilities through a range of interventions including:

� Contributing to the ‘10 Essential Shared CapabilitiesTraining Materials’90 and their uptake by local mentalhealth services.

� Building commitment by professional bodies so thatthe values and capabilities are built into pre-qualifyingtraining and continuing professional development forall mental health staff.

� Publishing guidance for commissioners on dayservices.

� Creating learning communities where peoplehave an opportunity to share successes, challengesand solutions.

Throughout the development of these resources, wehave identified the following as key determinants ofsocially inclusive practice in mental health organisations:leadership; coherence of policy and practice; andachieving specialisation without fragmentation.

Whilst some mental health services have appointed asocial inclusion lead and others have sought to embedsocially inclusive practice in all roles and activities, weknow that progress cannot be made without effectiveand strong leadership. The culture change necessary insome services creates certain barriers that slow progress.

Determined leadership efforts are needed to remainoptimistic, to relentlessly pursue change both within andbeyond the service, and sustain positive practice. Inparticular the role of people with mental health problemsand carers as ‘experts by experience’ needs to be furtherrecognised and built upon, particularly if the aspirationsof co-production are to be realised. This requires a radicalrethink about the nature of leadership in public servicesthat pays greater attention to building from strengths,ambitious futures, better outcomes and the challenge ofworking with complex systems of care and support.

If the mental health system is to promote sociallyinclusive opportunities for people who use their services,its own activities need to be organised in a way thataligns with these priorities. It must create a mentallyhealthy workplace, employ a representative proportion ofpeople who have mental health problems and listenrespectfully to people who use its services, carers andfrontline staff. It must build meaningful partnerships withinformal community organisations, whilst building upexternal capacity and promoting creative and responsiblerisk taking to further the interests of all partners.

Promoting social inclusion tends to be seen as importantbut not urgent work, and so it can be repeatedly pushedaside by crises unless dedicated time is allocated. As wellas specialising in inclusion work, substantial progress canbe made when workers share out responsibility forcommunity connection and capacity building in

33

mainstream community services. For example, if one staffmember builds ongoing links with the local university andanother establishes a relationship with the gym or thechurch, then sustained change can be achieved. Suchpartnerships create not only opportunities to bring freshskills and perspectives; they can also be an avenue toobtaining new sources of funding and expertise.

COMMUNITY ORGANISATIONSNSIP has made significant progress because it hasensured action to coordinate strategic and nationalintervention with local activities. For example, the CastleMuseum, in Nottingham has had a long standingassociation with mental health services and their localwork has been enhanced by involvement with the ‘Opento All’ national programme of mental health training formuseum staff commissioned by NSIP (see Chapter 5).Similarly, the 15-year history of links between the mentalhealth service and a large Further Education college hasbeen strengthened by the national network of educationregional project officers formed through our partnershipwith NIACE.

Our strategic and national interventions have created asupportive climate for local service delivery in severalareas of community life including employment,education, the arts and community development. Theseinterventions have blended obligation (such asinformation to employers about their duties under theDisability Discrimination Act) with good practiceexamples of what is possible, for example theawareness-raising activities targeted by NIACE at localFurther Education providers; and the formation oflearning communities, such as the NSIP AffiliatesNetwork.

It is also worth noting that while we have worked withlarge, networked, regulated and centrally funded

organisations we have felt it to be as important to workwith small, independent and self-run groups. Muchcommunity activity is informal, unregulated and short-lived and so the task of assisting such groups to offerpeople with mental health problems opportunities tocontribute must rely upon their individual relationshipswith mental health services.

Achieving spread and sustainability relies largely oneffective relationships between mental health servicesand community groups and organisations. Theserelationships need to assist people who use mentalhealth services to make the transition into engaging withthe community beyond the service, whilst retainingneeded supports. They need to monitor what is workingand be able to take action when support arrangementsare found to be inadequate. They need to collaborate onbuilding sustainable communities whilst ensuring thatfunding is used for the right purpose.

POLICY MAKERS, FUNDERS AND REGULATORSSocial inclusion work requires a panoramic view ofpolicy, funding, regional and local implementation,regulation and impact across a range of areas. Theseinclude employment, housing, learning and skills,transport, families, relationships and leisure. Also humanrights, civic responsibilities, access issues,neighbourhoods, service delivery and development.

Sustainable success demands:

� Effective links with local services and people, so thatproblems are quickly identified and addressed, whilesolutions are easily tested to see if they are fit forpurpose. This is important as frontline workerssometimes accept ineffective policy and regulationrather than set about changing it, while policy makerssometimes pay insufficient attention to local realities.

CHAPTER 7 SOCIALLY INCLUSIVE PRACTICE 34

ARTS AND MINDS NETWORKLeeds Partnership NHS Foundation Trust (LPFT) hasdeveloped a multi-agency partnership with a range ofarts organisations as well as voluntary and statutorypartners to establish the Arts and Minds Network.The partnership secured Arts Council funding for aseries of arts initiatives in health and social caresettings and seed-funding for an arts developmentpost. This funding has now been mainstreamed byLPFT with an Arts Development Manager andDevelopment Worker.www.artsandmindsnetwork.org.uk

DEVELOP (THE DEVELOPING VALUED LIFESTYLESPARTNERSHIP)Develop was formed in 2003. It is an informalconsortium of local mainstream organisations, mentalhealth service providers, people with mental healthproblems, their families and associates who worktogether promoting social inclusion in the LondonBorough of Bromley. Develop coordinatescollaborative networks and inclusive practice forumsusing one comprehensive infrastructure to supportinclusion at individual, service and community levels.www.developbromley.com

� Resources (people, skills and time) to scan the horizonacross a wide range of policy areas and respond toissues that might hinder or advance the inclusionagenda for people with mental health problems. Theseresources can be scarce at local level.

� Strategic alliances with mainstream communityorganisations to create dialogue, workable solutionsand convincing cases for change.

� A long-term approach that combines both insistencethat change is not delayed with the recognition thatpolicy, funding priorities and inspection criteria are notchanged overnight.

TRANSFERABILITY TO OTHER GROUPSThere is potential for synergy across traditional clientgroups. For example, services for people with learningdisabilities are currently seeking to increase the numbersin employment as part of the PSA 16 target becausethere are so few people with learning disabilities in work.As a result there has been little focus to date on jobretention for this group, while retention has been a majorfeature of employment work in mental health.

Similarly, the employment activity in learningdisability generates ideas about how to introduce a newgroup into the workforce and so offers solutions forpeople with long standing mental health problems whohave never worked. Coordination across traditional clientgroups will be increasingly important as more health andsocial care services adopt outward-facing approachesand so need to avoid, for example, employer, learningand volunteer organisations being inundated withuncoordinated requests for supported access andreasonable adjustments.

There are also positive examples of how links betweensocial inclusion and public health are being brought

together to have a positive impact on the experience ofpeople using mental health and other services.

Much more remains to be done if a socially inclusiveapproach is to be embedded in the day-to-daypractice of frontline mental health staff and if the barriersthat remain in mainstream community organisations areto be removed.

CONCLUSION

“I was in such a hopeless place I ended up in secondarymental health services. Then I took back control of meand have managed to travel quite a distance down myrecovery path. I have a life again.” 91

This report has detailed the work that has taken anessentially panoramic view of what was to be done. Ithas been rich in content and participative in process.We, the NSIP team, have been fortunate in having theopportunity to undertake work that is challenging andsatisfying in equal measure and which could layfoundations or set a compass point. We hope to havemade the most of the opportunity, building on theprevious effort of others to make at least some progressin the wide range of areas at which we have looked,taking the brief to do so from the equally broad remit ofthe SEU report.92 Thanks to external partnerships ofgreat goodwill and the immense collaborative commitmentof so many friends and colleagues, this progress, in aonce new, now well-established area of policy, has beencost effective and is progress of which we are proud.

The still central role of services and their expectations forpeople with mental health problems has determinedsomething of the focus of our work. There is a majorchallenge in how the role of services is to be transformedin the future. The fundamental importance, and value, ofengaged communities will need to be affirmed ever morewidely. Work on inclusion needs to look critically at theways in which services become part of, and accountableto communities themselves.

We need to see the changes of the last four yearsembedded in the activity of the next. This will require

35

STEPPING STONESA multi-agency programme, launched in 2008,enables Swindon’s key public sector employers tomaximise their disability equality initiatives by workingtogether and directly linking to local supportedemployment agencies. Between them these agenciessupport hundreds of highly motivated disabled peoplewho are actively seeking employment or workexperience opportunities. The initiative is led bySwindon Borough Council and now encompassesCapita, Swindon PCT, Great Western Hospitals NHSFoundation Trust and Wiltshire Police.

SMILE (SERIOUS MENTAL ILLNESS LEARNINGAND EVALUATION)The project utilised funding to create innovationschemes that improved the physical health of peoplewith serious mental health problems across a diversegroup of agencies using a range of interventions.

long-term coordination, regional support and localimplementation. It will also demand wide-ranging, robustand imaginative leadership, coupled with rigorousmonitoring of person-led, rather than service-led,outcomes and a strong, collaborative and practicalapproach to evidence development.

Combining these efforts will continue to involvepassionate commitment to the dignity of the individualbut it will need to balance this with closer and activereference to the potential of community life in the manyand diverse communities of which people with mentalhealth problems are a part. In this, there will be a needfor funding and prioritisation of resources to growmainstream capacity and to commission it effectively. Wehave tried to use an opportunity, limited by time, tocreate a web of action that can impact in such diversesettings because this is work that is often connected andcontingent rather than linear. Continuing progress willmean extending this impact.

Responsibility, leadership and a level of effectivecoordination remain vital and the growing commitment ofcommissioner and regulator alike to the inclusion agendais both welcome and essential. Nevertheless, thepractical requirements of innovation, engagement andshared learning across awkward and complexboundaries over time will demand a pluralism inapproach to change. Like much else, inclusion canreasonably be held to be everyone’s responsibility and inthis context, simple delivery solutions based on orthodoxassumptions of responsibility for action may produce anoutcome that is short-lived, especially in a structuralenvironment in which authority for action is highlydevolved.

This report is a resource to help with the process of localprogress in the future. It conveys ideas, reflectsexperience and points to the range of practical tools andspecific resources that we have produced to helpwith this local progress. Again, we thank everyone whohas supported our efforts and allowed us to capitalisetheirs. The work continues in ways that are andmust be evolutionary. Inclusion in mental health is amoral imperative. Its achievement will necessarily bework in progress.

CHAPTER 7 SOCIALLY INCLUSIVE PRACTICE 36

89 Department of Health, op. cit., 2007.

90 Department of Health, op. cit., 2004.

91 NSIP Reference Group Member.

92 Social Exclusion Unit, op. cit., 2004.

ANNEXES37

PROGRESS SINCE 2004Research and evidence is an underpinning strand ofwork that has run across the NSIP work streams.

In 2004 the key focus was to identify reliable sourcesand gather national and regional data to establish abaseline against which progress can be assessed overtime. However, there have been areas in which routinedata are not readily available and areas in which theevidence base is weak. Although research projects havebeen commissioned as part of the implementationprogramme to address some of the identified gaps,further work has been needed. NSIP and Shift have bothhelped to continue strengthening the evidence base onmental health and social inclusion. For example by:

i Hosting a symposium bringing together researchersand representatives from a range of organisationsand networks with an interest in mental healthand social inclusion research and evidence.From this, a collaborative research and evidencecoalition has been established as a mechanismfor developing a strategic approach to strengtheningthe evidence base.

ii Supporting the INDIGO project (International Study ofDiscrimination and Stigma Outcomes), which willestablish detailed international data on how stigmaand discrimination affect the lives of people with adiagnosis of schizophrenia, from the point of view ofpeople with mental health problems themselves. Theproject has been completed and is due to bepublished early 2009.

iii Establishing an Interactive Inclusion Database toprovide a multi-layered search tool allowing agradually narrowing search across regions, lifedomains, towns and project names. The databasecontains good practice and information about existingsocially inclusive projects throughout the country andis a useful resource both regionally and nationally.

iv Sitting on a mental health group, convened by theSainsbury Centre for Mental Health (SCMH), to workon key performance indicators for work andemployment. It will produce a toolkit that can be usedto monitor employment services and outcomes –including indicators on local employment context,client characteristics, service effectiveness indicatorsand individual level outcomes and this is due forpublication in 2009.

v Sitting on the advisory group for the Adult PsychiatricMorbidity Survey 2006/07; new topics introduced

include social capital and participation, discriminationand sexual identify, religion and spirituality.

vi Contributing to a research study on the benefits andoutcomes of participation in mental health artsprojects. The study was conducted by a team fromAnglia Ruskin University and the University of CentralLancashire (UCLan). Its purpose was to identifyappropriate indicators of mental health aimed at socialinclusion outcomes and, to develop and implementan evaluation framework based on these. The work:

� Included a survey of arts and mental healthprojects in England to map the range of activity andestablish what evaluation data projects collect.

� Conducted a retrospective analysis of data fromtwo projects in relation to their health and socialbenefits.

� Developed indicators and measures to evaluatearts projects.

The research team also validated a measuring tool forthe impact of arts participation on promoting socialinclusion.

NEXT STEPSThis work is critical to developing and measuring theimpact of social inclusion policy implementation. Theresearch network has supported the development ofeffective research approaches to inclusion and the movetowards evaluating progress in key areas.

There is a need to continue to grow an effective andpractical evidence base for inclusion. Academic/practicepartnerships will be key to this. Through UCLan, NSIPhas established an academic network involving some tenuniversities and is linked to international academicsettings to develop this work. Led by UCLan from a neworganisation within the International School forCommunity, Rights and Inclusion, the network will seekto drive the research agenda in practical ways,collaborating on bids and working to support localevaluation and knowledge transfer.

A strategic network for social care leads in trusts hasbeen established in partnership with SCIE and acommissioning network has been created to developsocially inclusive outcomes. Specific work is beingundertaken in the Eastern region with the regionaldevelopment centre and Strategic Health Authority tosupport local PCTs with outcomes development.

Equally, it will be important to work in the other domainsof community life where there are still major barriers to

ANNEX A RESEARCH AND EVIDENCE 38

social participation. We will seek to challenge thosebarriers and in the process help reduce thediscrimination that they cause. We will do this byoptimising shared learning and innovation; buildingfurther the evidence base for inclusion in practical ways;working with our partners in support of real change at alllevels in services and beyond; and taking particularaccount of new regional and local organisations and theopportunities that they represent.

The key priorities for the coming year include:

� Identifying a range of stakeholders and expandingmembership of the group, particularly focusing on theengagement of researchers with experience of peoplewith mental health problems in the process.

� Developing communication and disseminationsystems, including links with service providers and theacademic community, as a means of sharing relevantevidence and research findings more widely.

� Coordinating research activity and facilitatingcommunities of interest around specific topics andissues.

� Exploring opportunities for collaboration tosecure funding for research to strengthen theevidence base. Also for influencing existing researchstreams to ensure a focus on social inclusion issuesand outcomes.

39

2009Outcomes Framework for Mental Health Serviceswww.socialinclusion.org.uk/home/index.php

National Social Inclusion Programme FourthAnnual Updatewww.socialinclusion.org.uk/publications/4th_AnnualReview.pdf

2008How will my newly redesigned day service help me?www.socialinclusion.org.uk/publications/DayServicesLeaflet.pdf

Finding and Keeping Workwww.socialinclusion.org.uk/publications/Toward_a_MH_emplo

yment_strategy_revsied_after%20repairs.pdf

‘Open to All’ Mental health and Social InclusionAwareness Training for Museums and Gallerieswww.socialinclusion.org.uk/work_areas/index.php?subid=93

From segregation to inclusion: Where are we now?www.socialinclusion.org.uk/publications/NSIPDSReview.pdf

The Really Useful Book of Learning and Earningwww.socialinclusion.org.uk/publications/ReallyUsefulBook.pdf

2007National Social Inclusion Programme Third AnnualUpdatewww.socialinclusion.org.uk/publications/NSIP32007.pdf

Outcome Indicators Framework for Mental HealthDay Serviceswww.socialinclusion.org.uk/publications/DSdoccover1.pdf

2006National Social Inclusion Programme SecondAnnual Reportwww.socialinclusion.org.uk/publications/NSIP_AR2006.pdf

Improving the effectiveness of rent arrearsmanagement for people with mental health problemswww.socialinclusion.org.uk/publications/Rentarrearsbriefing.pdf

Vocational services for people with severe mentalhealth problems: Commissioning guidancewww.socialinclusion.org.uk/publications/

DOH_Vocational_web.pdf

From segregation to inclusion: Commissioningguidance on day services for people with mentalhealth problemswww.socialinclusion.org.uk/publications/Day_Services_web.pdf

Direct Payments for people with mental healthproblems: A guide to actionwww.socialinclusion.org.uk/publications/

Direct_Payments_web.pdf

An introduction to Direct Payments in mental healthservices: Information for people eligible to usemental health services and carerswww.socialinclusion.org.uk/publications/Direct_Payments_SU_

Guide.pdf

Choice Based Lettings for People with Mental HealthProblems: A Briefing Guidewww.socialinclusion.org.uk/publications/NSIP_CBL_briefing.pdf

2005Direct Payments in mental health: What are theybeing used for?kc.csip.org.uk/upload/Examples%20of%20DP.pdf

National Social Inclusion Programme First AnnualReportwww.socialinclusion.org.uk/publications/

NSIP_AnnualReport_FIN.pdf

JOINT OR COMMISSIONED PUBLICATIONS WITHPARTNER ORGANISATIONS

Connect and Include – an exploratory study ofcommunity development and mental health CDF,commissioned by NSIPwww.socialinclusion.org.uk/publications/CDFFINAL.pdf

Work Matters: Vocational Navigation forOccupational Therapy Staff, jointly published withthe College of Occupational Therapistswww.socialinclusion.org.uk/publications/

Work%20Matters%20Booklet%20for%20CD.pdf

Mental Health, Social Inclusion and Arts: developingthe evidence basewww.socialinclusion.org.uk/publications/MHSIArts.pdf

Getting through: Access to mental health servicesfor people who are homeless or living in temporaryor insecure accommodation. A good practice guidewww.socialinclusion.org.uk/publications/Gthroughguide.pdf

Action on Mental Health: A Guide to PromotingSocial Inclusionwww.socialinclusion.org.uk/publications/

Action_on_Mental_Health%20Fact_Sheets.pdf

Mental Health and Social Exclusionwww.socialinclusion.org.uk/publications/SEU.pdf

ANNEX B PUBLICATIONS AND RESOURCES 40

CURRENT TEAM MEMBERS (INCLUDING SECONDEESAND PART-TIME CONTRIBUTORS)

Malcolm BarrettLocal Liaison and User Development

Peter BatesDevelopment Consultant

Victoria BettonTrust Development Associate

Alex BurnerService User Involvement Lead

Marco CarreraProgramme Coordinator

David ClarkeRegional Employment Team Coordinator

Fabian DavisAssociate Director

Claire EtchesSocial Exclusion Lead

Dave GardnerCommissioning Associate

Naomi HankinsonAssistant Director

Fiona HillPA to David Morris

Kathryn JamesAssistant Director Learning and Skills

Robin JohnsonHousing Lead

Neil LowtherAssistant Director Employment

David MorrisProgramme Director

Robin Murray NeillPersonalisation Lead

Marian NaidooArts Lead

Steve OnyettLeadership Associate

Zoe RobinsonBusiness and Communications Director

Stafford Scott‘Communities of Influence’ Manager

Ben TaylorDay Services Lead

EXPERT ADVISORS

Diane Hackney

Sona Peskin

Fran Singer

Rosemary Wilson

REFERENCE GROUP

Les Aqil

Susan Ambury

Gerry Bennison

Randall Chan

Bev Chipp

Penny Connorton

David Cooke

Kaaren Cruse

John Holmes

Lorraine Looker

Tony Martin

Micheal Osbourne

Lizzie Walker

Robert Walker

Mike Walsh

PAST TEAM MEMBERS

Sue ChristoforouVoluntary Sector Lead

Christa DrennanAssistant Director Community Participation

Simon FrancisEmployment Lead

Antonia FurmstonAdministrator and Events Coordinator

Sarah HillBusiness and Communications Director

Clare MahoneyChildren and Families Lead

Rebecca MitchellProgramme Coordinator

Annette ReinliProgramme Coordinator

Miles RinaldiHead of Delivery

41ANNEX C ACKNOWLEDGEMENTS

CSIP

Paddy CooneyCSIP Executive Lead

NIMHE

Peter HornNIMHE Executive Lead

SOCIAL INCLUSION AND REGIONALEMPLOYMENT TEAM LEADS

Carey Bamber

Marion Blake

Sarah Joy Boldison

Stephany Carolan

Barbara Crosland

Shawn Crowe

Trish Crowson

Huw Davies

Mary Dunleavy

Jennette Fields

Lynne Hall

John Howat

Louise Howell

Neil Johnson

Brendan McLoughlin

Kate O’Hara

Jude Stansfield

Colin Williams

NSIP would like to thank all of the people andorganisations that have helped to improve socialinclusion outcomes for people with mental healthproblems, especially:

Barnardos

British Psychological Society

College of Occupational Therapists

Community Development Foundation

Learning and Skills Council

Mental Health Foundation

Mind

New Economics Foundation

National Institute of Adult Continuing Learning

Richmond Fellowship

Royal College of Nursing

Royal College of Psychiatrists

Rethink

Sainsbury Centre for Mental Health

Social Care Institute for Excellence

University of Central Lancashire

ANNEX C ACKNOWLEDGEMENTS 42

design: www.gilldavies.co.uk

www.socialinclusion.org.uk