Fund Life

Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ Pavilion Conference, Leeds ￭ 6th December 2012 ￭

Not services: Reforming Mental Health

The Centre for Welfare Reform

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

• Move away from meritocratic thinking, instead value human diversity & equality

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

• Innovate to build practical alternatives

You can call anything a ‘reform’ but it doesn’t make it so.

Government’s welfare reforms are not reforms but cuts.

Key points

1.Mental health is ripe for reform

2.Our context is changing radically

3.Personalisation & PBR opens doors

4.But real change will be from people

1. Mental health system is crazy

• Funding for mental health services is currently invested in the wrong things

• Improving mental health has more to do with citizenship and community than with services

• Current systems of funding and commissioning have made no difference

• Personalisation and greater community-focus could change that

• Peer support will change that

Fund life: a perspective

These findings [better long-term outcomes for schizophrenia in developing countries] still generate some professional contention and disbelief, as they challenge outdated assumptions that generally people do not recover from schizophrenia and that outcomes for western treatments and rehabilitation must be superior. However, these results have proven to be remarkably robust, on the basis of international replications and 15-25 year follow-up studies. Explanations for this phenomenon are still at the hypothesis level, but include:

1. greater inclusion or retained social integration in the community in developing countries, so that the person retains a role or status in the society

2. involvement in traditional healing rituals, reaffirming community inclusion and solidarity

3. availability of a valued work role that can be adapted to a lower level of functioning

4. availability of an extended kinship or communal network, so that family tension and burden are diffused, and there is often less negatively 'expressed emotion' in the family

Dr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countries learn from Developing Countries? World Psychiatry 2006, 5: 21-24

Managing a serious health condition 64%Finding a safer place to live 27%Living with childhood abuse 51%Didn’t finish their education 76%Recent experience of domestic violence 85%Fractured family (for those with young families) 66%Children experienced abuse (for those with children) 55%Living with a severe level of mental illness 55%Living with some mental illness 91%History of drug or alcohol misuse 52%Victim of crime 41%Perpetrator of crimes 39%Worried by debt or lack of money 65%

Of 44 women working with WomenCentre:

Lots of services, no support

Multiple reinforcing erosion of personal resilience

Our hypothesisPoor mental health is a function of real poverty

Service label N Urgent problem N Real need N

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

Mentally Ill 39 Housing 48 To overcome past trauma

54

Criminal 35 Benefits 46 To manage current trauma

51

Poor Mother 33 Health 37 To stop being bullied

50

Misuses Alcohol 24 Rent 32 Guidance 50

Uses Drugs 22Criminal Justice Advocate 24 Relationship skills 45

Violent 19 Dentistry 8 Mothering skills 26

Chronic Health Condition

16 Others 3 Others 1

Our proper focus should bereal wealth and the human spirit

2. It’s enough to make you mad

[Source: HM Treasury, 2010 October Spending Review]

Some big growth and some big cuts

Biggest growth is in central spending

Big cuts to benefits and social care

• End of Disability Living Allowance• Cuts in Housing Benefit & Council Tax benefit• Reductions in Access to Work• Reduced eligibility for ESA• Increasingly intrusive testing by ATOS• Introduction of Universal Credit• Benefits reindexed to increase poverty• End of Independent Living Fund• Increased eligibility for social care• Increasing bureaucracy in social care• Reducing budget levels in social care• Return people to institutions and care homes• Increasing social care charges• Increased taxes, e.g. VAT, Council tax• and many, many other measures

What will be impact?

Mental health will deteriorate as

1.Inequality will increase

2.Stigmatisation will increase

3.Real poverty will increase

Income inequality correlated with mental illness

45% of people in debt have mental health problems compared to 14% of people who are not in debt

Developing unmanageable debt is associated with an 8.4% risk of developing a mental health problem compared to 6.3% for people without financial problems (i.e. a third higher)

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

Martin Knapp, 2012 Tizard Lecture

Some of this may be caused by practical aspects of poverty, e.g. debt:

Some of this may be caused by psychological aspects of poverty, e.g. stigma:

Chick Collins on the ‘Scottish Effect’

By 2015 benefits - will be cut by more than £18 billion, local government in England will be cut by £11.3 billion. 50% of local government spending is on social care for disabled people.

58% of all cuts target disabled people and people in poverty

36% of all cuts target disabled people

24% of all cuts target those who need social care - 1.9% of the population

Current cuts will target and further stigmatise particular groups, e.g. disabled people

Rather than reducing inequalities itself, the initiatives aimed at tackling health or social problems are nearly always attempts to break the links between socio-economic disadvantage and the problems it produces. The unstated hope is that people - particularly the poor - can carry on in the same circumstances, but will somehow no longer succumb to mental illness, teenage pregnancy, educational failure or drugs.

Wilkinson & Pickett, The Spirit Level

Mental health spending itself may not decrease much, but this is not necessarily a good thing

1. Human Rights - Better fundamental legislation

2. Clear Entitlements - Its ‘my budget’

3. Avoid Crisis - Family support, lower thresholds

4. Full Access - No ‘special’ funding for services

5. Choice & Control - Freedom, capacity

6. Fair Incomes - Enough for citizenship

7. Fair Taxes - No ‘special taxes’, no charges

8. Sustainability - Rethink health/social care split

Campaign for a fair society

3. Opening the doors of the asylum

Emerging themes in policy

1.Personalisation still has momentum

2.GPs may have more influence

3.LAs may have more influence

4.Social care will be slashed

5.PBR may make a difference

Let’s not be naive about policy change

jargon or new reality?

the need for entitlements

the search for accountability

opening up new forms of control

I used to work in the fashion design industry as a product developer until I became ill. This was a hard time in my life. I was diagnosed with paranoid schizophrenia...

...as I am now on the road to recovery my budget has reduced. I have updated my plan myself and this has given me the opportunity to talk about what I want for the future. The opportunity to be creative is very important to me and is something that keeps me well. I now receive a little support and a one off payment which I use to help me to buy equipment to make jewellery. I hope that I will eventually be able to teach other people how to make jewellery to give something back. My goal is to start up my own jewellery business and be financially self-supporting, and the recovery team is helping me with this.

Without the support that I have I would still be wondering where my life is going, but now I have hopes for the future. I would definitely recommend considering a personal budget. You can really make it work for you in a way that I didn’t know was possible. I feel lucky that I have been able to get back some of the life I have lost.

From Health Efficiency by Alakeson & Duffy

personalised support means...

creative support for folk with complex needs

Transportation 13% Crafts 2%

Computers and accessories 12% Licenses/ certification 2%

Dental services 11% Entertainment 2%

Medication management services 8% Vision services 2%

Psychotropic medications 8% Furniture 1%

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

Housing 7% Camera and supplies 1%

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

Utilities 3% Haircut, manicure etc. 1%

Travel 3% Pet ownership 1%

Equipment 3% Supplies and storage <1%

Clothing 2% Other <1%

Food 2% Total 100%

the need to change investment patterns

integration through personalisation

LA Resources ‘Social Care’ Well-being?

NHS Resources Medical services Clinical outcomes?

Welfare funding ‘what works’ Improved mental health

rethinking outcomes

• Total place - the Humpty-Dumpty challenge

• Community sourcing - individuals, communities and local organisations

• Innovate - you can’t move without changing

• Measure - focus on what really matters

Rethinking commissioning

Localism anyone?

4. Don’t get mad, get even

WomenCentre:

1.Start with the whole woman - gendered and holistic

2.Offer a positive and comprehensive model of support - every woman is a one-stop-shop

3.Build a bond of trust - create the means for woman to do real work together

A positive model of service...

5 and 1/2 levels of support

Knitting together the bond of trust

The future social worker?

Time to Campaign?

Fund Life

Questions for you...

1.Do you believe change is possible?

2.Do you believe you can be part of it?

3.Will you work with us to make it happen?

If so...

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www.centreforwelfarereform.org

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www.centreforwelfarereform.org

Subscribe and Follow

You can also joinwww.campaignforafairsociety.org

#FairSociety

You can also joinwww.campaignforafairsociety.org

#FairSociety

These slides are © Simon Duffy 2012 ￭ Publisher is The Centre for

Welfare Reform ￭ Slides can be distributed subject to conditions

set out at www.centreforwelfarereform.org

These slides are © Simon Duffy 2012 ￭ Publisher is The Centre for

Welfare Reform ￭ Slides can be distributed subject to conditions

set out at www.centreforwelfarereform.org