mental health day services

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? ? ? ? ? ? ? ? ? ? ? ? mental health day
services? ? ? ? ? ? ? ? ? ? ? ?

• CSIP Eastern, Day Services Network
• Wednesday, 7th June, 2006
• Chris Rowland, Programme Manager - Social
  Inclusion
• CSIP Eastern Development Centre

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Care Services Improvement PartnershipTo
support care services to improve the quality of
life for people of all ages who receive such
services.- National Institute for Mental
Health in England (NIMHE) - Integrated Community
Equipment Services (ICES)- Health Social Care
Change Agent Team (CAT)- Change for Children
(CfC) - Integrated Care Network (ICN)- National
CAMHS Support Service (NCSS)- Valuing People
Support Team (VPST)- Prison Health Team
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running order

• 10.30 Housekeeping and introductions
• 10.40 Social exclusion what is it, why is it,
  what can we do about it?
• Where do mental health day services fit?
• 11.00 Group Exercise What do we want from our
  day services?
• 11.30 Refreshments
• 11.45 Group Exercise Where are we now? What
  would help?
• 1.00 Lunch

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Introductions

• Chris Rowland, Programme Manager for Social
  Inclusion, Care Services Improvement Partnership
  - CSIP.
• Leading the Social Inclusion Programme across the
  Eastern Region.
• Previous experience of mental health service
  management in the voluntary sector.
• Also responsible for supporting the development
  of the voluntary and community sector in the
  Eastern Region.
• But

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Defining social exclusion

• Social exclusion is
• what can happen when people suffer from a
  combination of linked problems such as
  unemployment, poor skills, low income, poor
  housing, high crime, bad health and family
  breakdown
• whose most important characteristic is that
  these problems are linked and mutually
  reinforcing and can combine to create a complex
  and fast moving vicious cycle.
• Preventing Social Exclusion
• Social Exclusion Unit, 2002

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Dimensions affecting Social Inclusion and their
indicators

• Economic
• Long-term unemployment
• Job insecurity
• Workless households
• Income poverty
• Social
• Breakdown of traditional households
• Unwanted teenage pregnancies
• Homelessness
• Crime
• Disaffected youth
• Social disturbance/disorder
• Political
• Disempowerment
• Lack of political rights
• Low registration of voters
• Low voter turnout

Locality Environmental degradation Decaying
housing stock Withdrawal of local services
Collapse of support networks Concentration/margi
nalisation of vulnerable groups Individual Mental
and physical ill health Educational
underachievement/low skills Loss of self-esteem/
confidence Groups / Diversity Concentration of
above characteristics in particular groups
Disabled people Ethnic minorities Elderly
etc.
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Social exclusion causes

• Poor housing
• Poor access to community resources
• Stigma and discrimination
• Isolation
• Poor health (physical and mental)
• Unemployment
• Poor access to support services
• Low income
• Lack of community cohesion and integration

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and effects

• Lower life-expectancy
• Higher suicide rate
• Greater incidence of poor mental and physical
  health
• Greater demand on services
• Lower contribution to the economy
• Greater demand on the benefits system
• Higher rate of divorce and family breakdown (with
  resultant repercussions for children etc)
• Entering into a self-reinforcing cycle of
  exclusion from which it is difficult to escape.

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Mental health and social exclusion

• We formally exclude people with mental health
  problems
• In the mental health system (asylums, long stay
  hospitals, segregated day services, specialist
  mental health services)
• Stigma is greater in societies with a history of
  expert care (Jean-Luc Roelandt, 2004).
• In society (jury service, rights, school
  governance, etc)
• We culturally exclude mental distress (shame,
  guilt, social stigma, resulting in
  discrimination).

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Mental health inequalities

• Only 23 of people with a severe and enduring
  mental health problem are in full-time work,
  compared with 65 of people with a physical
  disability, and 75 of the general population.
• A person with schizophrenia can expect to live
  for 10 years less than someone without a mental
  health problem mainly because of physical
  health problems.
• Depression increases the risk of heart disease
  fourfold.
• Deaths from smoking-related diseases are twice as
  high among people with schizophrenia.
• Someone who has been on Incapacity Benefit for
  longer than two years is more likely to retire or
  die than ever return to work.
• There is a strong correlation between poor mental
  health and social disadvantage (e.g. poverty,
  poor education, unemployment), and a strong
  correlation between unemployment and suicide.
• Suicide is (still!) the highest single cause of
  death in the under-35s.

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What can we do about it?

• Not about new services, but about changing how we
  think about, design and provide mental health
  services.
• It is a change of outlook, philosophy, culture,
  reaching across the whole service system, beyond
  a medical model of treating mental illness.

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Top Ten issues by percentage of respondents who
raised them

• Impact of Stigma/lack of understanding of MH
  issues 83
• Support to gain employment/overcoming
  barriers 72
• Benefits Issues 62
• Lack of social networks/access to social
  activities 53
• Access to employment more generally 53
• Lack of self confidence/social withdrawal 52
• Education/awareness raising of mental health
  issues 49
• Employer focussed interventions 48
• Access to recreation leisure/sport/art/libraries
  38
• Mental health symptoms and side effects 34

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What can we do about it?

• Not about new services, but about changing how we
  think about, design and provide mental health
  services.
• It is a change of outlook, philosophy, culture,
  reaching across the whole service system, beyond
  a medical model of treating mental illness.
• Holistic whole life approach to mental and
  emotional health and well-being.
• Whole systems approach to mental health service
  delivery.
• Focus on inclusion, equality of access, choice
  and diversity of provision diagnosis/disability
  will not be the criteria of inclusion/exclusion.
• Focus on health promotion, preventative
  interventions and recovery.

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Recovery Principles 1

• Principle I
• The user of services decides if and when to
  begin the recovery process and directs it
  therefore, service user direction is essential
  throughout the process.
• Principle II
• The Mental Health System must be aware of its
  tendency to promote service user dependency.
  Users of service need to be aware of the negative
  impact of co-dependency.
• Principle III
• Users of service are able to recover more
  quickly when their
• Hope is encouraged, enhanced and/or
  maintained
• Life roles with respect to work and
  meaningful activities are defined
• Spirituality is considered
• Culture is understood
• Educational needs as well as those of
  families/significant others are identified
• Socialisation needs are identified.
• They are supported to achieve their goals.

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Recovery Principles 2

• Principle IV
• Individual differences are considered and valued
  across the life span.
• Principle V
• Recovery from mental illness is most effective
  when a holistic approach is considered this
  includes psychological, emotional, spiritual,
  physical and social needs.
• Principle VI
• In order to reflect current "best practices"
  there is a need for an integrated approach to
  treatment and care that includes
  Medical/biological, Psychological, Social and
  Values Based approaches. A Recovery approach
  embraces all of these.
• Principle VII
• Clinicians and practitioners initial emphasis on
  hope and the ability to develop trusting
  relationships influences the recovery of users of
  services.
• Principle VIII
• Clinicians and practitioners should operate from
  a strengths/assets model.

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Recovery Principles 3

• Principle IX
• Users of service with the support of clinicians,
  practitioners and other supporters should develop
  a recovery management or wellness recovery action
  plan. This plan focuses on wellness, the
  treatments and supports that will facilitate
  recovery and the resources that will support the
  recovery process.
• Principle X
• Involvement of a persons family, partner and
  friends may enhance the recovery process. The
  user of service should define whom they wish to
  involve.
• Principle XI
• Mental Health services are most effective when
  delivery is within the context of the service
  users locality and cultural context.
• Principle XII
• Community involvement as defined by the user of
  service is central to the recovery process.

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Some practical ways in which we can promote
inclusion

• Look at our individual, professional, and
  organisational values, and how these impact on
  service delivery
• Developing (mental health) services in a primary
  care setting (e.g. depot clinics, case
  management, vocational support, benefits advice).
• Develop strong links with mainstream community
  resources
• Support the increased use of direct payments (and
  individual budgets as these are developed).
• Ensure that vocational needs and aspirations are
  recognised and supported at all stages of contact
  with services
• Redesigning (mental health) day services (open
  access, non-segregated, community facing,
  supporting integration).

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day service redesign(why do it / how do it?)
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Features of day service (2005)

• Closed referral system MH specific.
• Physical place where people go / gather / attend
  (bricks and mortar!).
• Limited connection to mainstream community
  services / resources (both from staff and service
  users).
• Socially excluding!

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Heterogeneous elements of day services(2005)

• Social environment / social support / peer
  support.
• Daily occupation (e.g. music group, magazine
  group, art group, walking group) but generally
  not vocational support.
• Rehabilitation (e.g. cooking group, IT session).
• Care coordination / medical support (e.g. depot
  clinic).
• (Psychological) therapies / groups (e.g. anger
  management).
• Day hospital intensive / crisis day support.

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Features of day service redesign.

• Needs mapping / service mapping.
• Engaging service users (present and potential).
• Mapping community resources.
• Engaging stakeholders (including staff, other
  mental health services, community resources
  including JC, education providers etc).
• Building community engagement / capacity.
• Managing change (funding, culture, training,
  support to existing service users).

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Day services 2010 need to

• Recognise agendas around disability, race
  equality, etc
• Recognise the needs of asylum seekers, traveller
  communities, and migrant workers.
• Incorporate services for people with an offending
  background people with substance misuse
  problems people with a learning disability
• Meet the needs of the rural communities.

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Day services 2010 could be

• Not building based, perhaps even outreach model
• Supported by direct payments.
• 121 support model
• Person centred (and planned around strengths).
• Non clinical
• Focus on vocational support
• Community engaged
• Community facing
• If there is a building, open access

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How can we support you?

• Please contact me at CSIP Eastern Regional
  Development Centre if you would like to discuss
  any aspect of this presentation, or how we might
  support you or your agencys work locally.
• chris.rowland_at_nemhpt.nhs.uk
• 07747-536065