Care and support are not the only models or frameworks for mental health recovery. The establishing or re-establishing of what Dr. Pat Deegan refers to as 'valued social roles' can be held back by a mental health system that often encourages the client to choose 'a career in mental health' (Pat Deegan).
A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.
Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.
A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client not by the bridge builder.
Wednesday 25 August 2010
Mainstream - the cascade effect
As a social inclusion bridge builder I work with clients with severe and enduring mental health diagnoses. They are referred or they self-refer with the desire to access mainstream life domains.
Clients aspire to a variety of mainstream choices. It might be volunteering or befriending, it may be arts activities, it might be employment or running your own business. Client aspirations may include sports, faith, education, training or a selection from any or all of these.
Enabling individuals with a 'severe and enduring' background is not always a straightforward process although it certainly can be sometimes. A client can be introduced to a mainstream outlet and it can work for him or her almost immediately. Other clients may be unready for mainstream for a variety of reasons. They may suffer a relapse before accessing the mainstream environment. They may visualise mainstream as another form of day service or statutory support system, which it isn't.
Equally, clients can sometimes express a wish to access mainstream out of a misplaced fear that not accessing it might in some way affect their payments and benefits. It can be a long process before the value and rewards of mainstream are understood.
What is true is that clients who successfully access or re-access mainstream in turn become examples of mainstream's effectiveness. Signposting to mainstream as part of the mental health recovery pathway is undoubtedly effective, even if it does not work for everyone straight away.
Mainstream also helps to sustain recovery in the individual and even better, it can propagate more success and recovery out of its own resources. An example of this would be the musician who successfully links up with a mainstream recording studio. After months of regular rehearsal the musician is invited by the studio manager to contribute to a recording session. I witness this kind of beautiful outcome and its benefits for the client in my work as an arts bridge builder.
Another example - again from music bridge building - is the guitarist client who uses a studio regularly and invites a friend to join him during the session. The friend may well be another mental health service user who has never successfully engaged with mainstream despite the best efforts of the bridge building service. Where services have been unsuccessful a friendship and peer network can do the job far more effectively.
Mainstream reaches the places other services cannot reach and in the process it is able to create a cascade effect - a continuing path of development, recovery and individual growth.
Clients aspire to a variety of mainstream choices. It might be volunteering or befriending, it may be arts activities, it might be employment or running your own business. Client aspirations may include sports, faith, education, training or a selection from any or all of these.
Enabling individuals with a 'severe and enduring' background is not always a straightforward process although it certainly can be sometimes. A client can be introduced to a mainstream outlet and it can work for him or her almost immediately. Other clients may be unready for mainstream for a variety of reasons. They may suffer a relapse before accessing the mainstream environment. They may visualise mainstream as another form of day service or statutory support system, which it isn't.
Equally, clients can sometimes express a wish to access mainstream out of a misplaced fear that not accessing it might in some way affect their payments and benefits. It can be a long process before the value and rewards of mainstream are understood.
What is true is that clients who successfully access or re-access mainstream in turn become examples of mainstream's effectiveness. Signposting to mainstream as part of the mental health recovery pathway is undoubtedly effective, even if it does not work for everyone straight away.
Mainstream also helps to sustain recovery in the individual and even better, it can propagate more success and recovery out of its own resources. An example of this would be the musician who successfully links up with a mainstream recording studio. After months of regular rehearsal the musician is invited by the studio manager to contribute to a recording session. I witness this kind of beautiful outcome and its benefits for the client in my work as an arts bridge builder.
Another example - again from music bridge building - is the guitarist client who uses a studio regularly and invites a friend to join him during the session. The friend may well be another mental health service user who has never successfully engaged with mainstream despite the best efforts of the bridge building service. Where services have been unsuccessful a friendship and peer network can do the job far more effectively.
Mainstream reaches the places other services cannot reach and in the process it is able to create a cascade effect - a continuing path of development, recovery and individual growth.
Thursday 19 August 2010
Planning for Good Mental Health & Social Inclusion
Commissioned by a major Surrey NHS Trust success the training 'Planning for Good Mental Health & Social Inclusion' has been a great success and is now running throughout 2010. Attendees include health visitors, GPs, occupational therapists, members, social workers and day centre workers. Library managers and staff have joined the training cohort, making for diverse and lively learning. The training has been put together by John Vanek, an experienced Social Inclusion bridge builder and qualified Mental Health First Aid Instructor.
The value of the one-day course is that it incorporates both mental health awareness as well as social inclusion assessment tools. Tools such as the 'web' and 'recovery star' are demonstrated along with an opportunity for attendees to do hands-on peer assessment. Many attendees have testified to the value of learning about social inclusion assessment and how it could be used for their own clients.
Current attendees on the 'Planning for Good Mental Health & Social Inclusion' course cover a broad range of professional disciplines from across NHS and commissioning services. These have included health visitors, social workers, a service commissioner, a GP, specialised physiotherapist and dieticians. Recently the trainings have been joined by library staff and managers. Employment services are also showing interest in commissioning the programme.
The course is designed to be of benefit for anyone who is a service provider, not specifically within the caring or health professions.
Typical groups who benefit from the trainings include:
Employers who wish to know more about common mental health conditions
Business owners who wish to address problems of lost productivity due to undiagnosed or diagnosed staff mental health problems
Anyone who wishes to know more about current mental health legislation and their legal rights and requirements.
Community-based workers who wish to learn about developments in social inclusion over the last fifty years.
HR practitioners who wish to gain simple assessment skills and tools for helping clients or employees make a successful return to mainstream life after illness or setback.
Health & Safety personnel keen to know more about what's out there for people who may be experiencing mild or more severe mental health challenges.
Testimonials from course attendees
The value of the one-day course is that it incorporates both mental health awareness as well as social inclusion assessment tools. Tools such as the 'web' and 'recovery star' are demonstrated along with an opportunity for attendees to do hands-on peer assessment. Many attendees have testified to the value of learning about social inclusion assessment and how it could be used for their own clients.
Current attendees on the 'Planning for Good Mental Health & Social Inclusion' course cover a broad range of professional disciplines from across NHS and commissioning services. These have included health visitors, social workers, a service commissioner, a GP, specialised physiotherapist and dieticians. Recently the trainings have been joined by library staff and managers. Employment services are also showing interest in commissioning the programme.
The course is designed to be of benefit for anyone who is a service provider, not specifically within the caring or health professions.
Typical groups who benefit from the trainings include:
Employers who wish to know more about common mental health conditions
Business owners who wish to address problems of lost productivity due to undiagnosed or diagnosed staff mental health problems
Anyone who wishes to know more about current mental health legislation and their legal rights and requirements.
Community-based workers who wish to learn about developments in social inclusion over the last fifty years.
HR practitioners who wish to gain simple assessment skills and tools for helping clients or employees make a successful return to mainstream life after illness or setback.
Health & Safety personnel keen to know more about what's out there for people who may be experiencing mild or more severe mental health challenges.
Testimonials from course attendees
Tuesday 17 August 2010
MHFA symptom-specific interventions
The Mental Health First Aid course prescribes ALGEE as an umbrella intervention for all mental health conditions, from general anxiety through to full-blown pychosis. Inevitably, MHFA does not demaind that an intervention is the same for every condition that presents. MHFA gives precise guidelines for the first aider who may be working with someone who is distressed and feeling suicidal. These guidelines are in addition to ALGEE Assessing risk, Listening non-judgementally, Giving reassurance, Encouraging referral to other agencies and Encouraging self-help strategies. For the person who is distressed and talking of suicide, MHFA guidelines are:
- If person is distressed and threatening do not get involved physically.
- Do not leave them alone, stay with them.
- Seek immediate help:
- phone their GP and ask them to come out
- dial 999
- take the person to the Accident & Emergency Department of the nearest hospital
- take the person to a GP
- call the NHS24 helpline
Monday 16 August 2010
MHFA testimonials
MHFA Training delivered by Middlesbrough and Stockton Mind on behalf of the NE Mind Partnership have trained over 1800 individuals with outstanding feedback and results.
Mental Health First Aiders were asked for there stories on how MHFA has helped them. These are just a small selection;
I use MHFA daily, for example I had a tenant suffering a psychotic episode which I felt confident to deal with
I have used MHFA when a young Mum came into the centre and told me she felt like ending it all
I use it on a daily basis with clients and colleagues and feel I have made a real difference
I have a work colleague who suffers from epilepsy and associated depression and anxiety. I used ALGEE and offered advice and guidance over the phone.
Mental Health First Aiders were asked for there stories on how MHFA has helped them. These are just a small selection;
I use MHFA daily, for example I had a tenant suffering a psychotic episode which I felt confident to deal with
I have used MHFA when a young Mum came into the centre and told me she felt like ending it all
I use it on a daily basis with clients and colleagues and feel I have made a real difference
I have a work colleague who suffers from epilepsy and associated depression and anxiety. I used ALGEE and offered advice and guidance over the phone.
MHFA Interventions
Mental Health First Aid (MHFA) promotes five basic interventions for a qualified mental health first aider who comes into contact with signs and symptoms of a mental health condition. The action plan for Mental Health has five basic steps under the mnemonic ALGEE.
1. Assess risk (to oneself and the client)
2. Listen non-judgementally
3. Give reassurance and information
4. Encourage the person to get appropriate help and support
5. Encourage self-help strategies
Mental health condition can present across a spectrum, from mild sub-clinical concerns through to severe anxiety, distress and even full-blown psychosis.
A mental health crisis can occur when a person may feel suicidal or having anxiety attacks or be in an acute stress reaction or a person may be out of touch with reality in a distressing psychotic state. MHFA helps participants to develop and practice general strategies in a safe environment, that can be used in a first aid situation.
For a more in-depth course on suicide intervention skills it is recommended to attend an ASIST (Applied Suicide Intervention Skills Training) course.
1. Assess risk (to oneself and the client)
2. Listen non-judgementally
3. Give reassurance and information
4. Encourage the person to get appropriate help and support
5. Encourage self-help strategies
Mental health condition can present across a spectrum, from mild sub-clinical concerns through to severe anxiety, distress and even full-blown psychosis.
A mental health crisis can occur when a person may feel suicidal or having anxiety attacks or be in an acute stress reaction or a person may be out of touch with reality in a distressing psychotic state. MHFA helps participants to develop and practice general strategies in a safe environment, that can be used in a first aid situation.
For a more in-depth course on suicide intervention skills it is recommended to attend an ASIST (Applied Suicide Intervention Skills Training) course.
Wednesday 11 August 2010
Derbyshire's Personalisation Champion
Personalisation, individual budgets, direct payments have all been around for some time. The particular significance for mental health and recovery is highlighted by some of the action that has been taken by service users.
Tony Martin has been speaking up for people with mental health problems since he started using services 15 years ago. In 2006 he took up a direct payment and became a convert to personalisation.
When the Department of Health started piloting individual budgets in 2005, he was appointed as a citizen leader tasked with promoting self-directed support.
Becoming a Mind personalisation champion was an extension of what he was doing already, though the cachet of saying he was working for Mind helped open more doors.
Martin aimed to increase the number of mental health service users with a direct payment in Derbyshire. As champion, he used his established links with the local primary care trust, the county council, government and with service users and service user forums.
He even held a conference on personal budgets to disseminate thinking. Attended by 140 people, including professionals, carers and service users, all groups felt they had learned a great deal.
Tackling professionals' attitudes and levels of knowledge about personalisation was key.
Martin says: "The real crux of it is ignorance in the service teams about how a direct payment can be used differently in mental health compared with in other groups, such as people with disabilities.
"It's no good thinking about how you can get people out of bed. It's about being able to give us new focuses and new interests in life and improving our quality of life."
Martin's analysis of 'ignorance in the service teams' is probably no longer as relevant as it was when he made the original comment. Mental health teams are very clued-in with the importance of direct payments as a potential route to mainstream above and beyond simple arrangements for care provision.
Service users like Martin and user groups are also pioneering creative uses for direct payments. Also, independent brokers working alongside mental health teams can help to ensure that direct payments and personalisation go hand-in-hand. Ultimately, personalisation can only exist for the sole purpose of enabling individuals' dreams, hopes and aspirations in the mainstream world.
Tony Martin's championing of direct payments for mental health led to a dramatic increase in take-up. By March 2010 there were 52 mental health service users with a direct payment in Derbyshire, up from 16 in September 2009, when Martin started his work as a champion.
Tony Martin has been speaking up for people with mental health problems since he started using services 15 years ago. In 2006 he took up a direct payment and became a convert to personalisation.
When the Department of Health started piloting individual budgets in 2005, he was appointed as a citizen leader tasked with promoting self-directed support.
Becoming a Mind personalisation champion was an extension of what he was doing already, though the cachet of saying he was working for Mind helped open more doors.
Martin aimed to increase the number of mental health service users with a direct payment in Derbyshire. As champion, he used his established links with the local primary care trust, the county council, government and with service users and service user forums.
He even held a conference on personal budgets to disseminate thinking. Attended by 140 people, including professionals, carers and service users, all groups felt they had learned a great deal.
Tackling professionals' attitudes and levels of knowledge about personalisation was key.
Martin says: "The real crux of it is ignorance in the service teams about how a direct payment can be used differently in mental health compared with in other groups, such as people with disabilities.
"It's no good thinking about how you can get people out of bed. It's about being able to give us new focuses and new interests in life and improving our quality of life."
Martin's analysis of 'ignorance in the service teams' is probably no longer as relevant as it was when he made the original comment. Mental health teams are very clued-in with the importance of direct payments as a potential route to mainstream above and beyond simple arrangements for care provision.
Service users like Martin and user groups are also pioneering creative uses for direct payments. Also, independent brokers working alongside mental health teams can help to ensure that direct payments and personalisation go hand-in-hand. Ultimately, personalisation can only exist for the sole purpose of enabling individuals' dreams, hopes and aspirations in the mainstream world.
Tony Martin's championing of direct payments for mental health led to a dramatic increase in take-up. By March 2010 there were 52 mental health service users with a direct payment in Derbyshire, up from 16 in September 2009, when Martin started his work as a champion.
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