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Fund Life, Not Services


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Presentation given at The Centre for Welfare Reform's conference on mental health reform in Leeds december 2012.

Presentation given at The Centre for Welfare Reform's conference on mental health reform in Leeds december 2012.

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  • 1. Fund LifeNot services: Reforming Mental Health Dr Simon Duffy ■ The Centre for Welfare Reform ■ Pavilion Conference, Leeds ■ 6th December 2012 ■
  • 2. 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
  • 3. You can call anything a ‘reform’but it doesn’t make it so.Government’s welfare reformsare not reforms but cuts.
  • 4. Key points1.Mental health is ripe for reform2.Our context is changing radically3.Personalisation & PBR opens doors4.But real change will be from people
  • 5. 1. Mental health system is crazy
  • 6. Fund life: a perspective• 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
  • 7. These findings [better long-term outcomes for schizophrenia indeveloping countries] still generate some professional contentionand disbelief, as they challenge outdated assumptions thatgenerally people do not recover from schizophrenia and thatoutcomes for western treatments and rehabilitation must besuperior. However, these results have proven to be remarkablyrobust, on the basis of international replications and 15-25 yearfollow-up studies. Explanations for this phenomenon are still atthe hypothesis level, but include:1. greater inclusion or retained social integration in thecommunity in developing countries, so that the person retains arole or status in the society2. involvement in traditional healing rituals, reaffirmingcommunity inclusion and solidarity3. availability of a valued work role that can be adapted to alower level of functioning4. availability of an extended kinship or communal network,so that family tension and burden are diffused, and there is oftenless negatively expressed emotion in the familyDr Alan Rosen from Destigmatising day-to-day practices: What Can DevelopedCountries learn from Developing Countries? World Psychiatry 2006, 5: 21-24
  • 8. Of 44 women working with WomenCentre: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%
  • 9. Lots of services, no support
  • 10. Our hypothesisPoor mental health is a function of real povertyMultiple reinforcing erosion of personal resilience
  • 11. Service label N Urgent problem N Real need NVictim of domestic 55 Debt 50 Better self-esteem 64violence To overcome pastMentally Ill 39 Housing 48 54 trauma To manageCriminal 35 Benefits 46 51 current trauma To stop beingPoor Mother 33 Health 37 50 bulliedMisuses Alcohol 24 Rent 32 Guidance 50 Criminal JusticeUses Drugs 22 24 Relationship skills 45 AdvocateViolent 19 Dentistry 8 Mothering skills 26Chronic Health 16 Others 3 Others 1Condition
  • 12. Our proper focus should bereal wealth and the human spirit
  • 13. 2. It’s enough to make you mad
  • 14. Some big growth and some big cuts[Source: HM Treasury, 2010 October Spending Review]
  • 15. Biggest growth is in central spending
  • 16. Big cuts to benefits and social care
  • 17. • 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
  • 18. What will be impact?
  • 19. Mental health will deteriorate as1.Inequality will increase2.Stigmatisation will increase3.Real poverty will increase
  • 20. Income inequality correlated with mental illness
  • 21. Some of this may be caused by practical aspects ofpoverty, e.g. debt:45% of people in debt have mental health problemscompared to 14% of people who are not in debtDeveloping unmanageable debt is associated withan 8.4% risk of developing a mental healthproblem compared to 6.3% for people withoutfinancial 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
  • 22. Some of this may be caused by psychologicalaspects of poverty, e.g. stigma: Chick Collins on the ‘Scottish Effect’
  • 23. Current cuts will target and further stigmatiseparticular groups, e.g. disabled peopleBy 2015 benefits - will be cut by more than £18billion, local government in England will be cut by£11.3 billion. 50% of local government spending ison social care for disabled people.58% of all cuts target disabled people and peoplein poverty36% of all cuts target disabled people24% of all cuts target those who need social care -1.9% of the population
  • 24. Mental health spending itself may not decreasemuch, but this is not necessarily a good thingRather than reducing inequalities itself, theinitiatives aimed at tackling health or socialproblems are nearly always attempts to break thelinks between socio-economic disadvantage andthe problems it produces. The unstated hope isthat people - particularly the poor - can carry on inthe same circumstances, but will somehow nolonger succumb to mental illness, teenagepregnancy, educational failure or drugs.Wilkinson & Pickett, The Spirit Level
  • 25. 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 splitCampaign for a fair society
  • 26. 3. Opening the doors of the asylum
  • 27. Emerging themes in policy1.Personalisation still has momentum2.GPs may have more influence3.LAs may have more influence4.Social care will be slashed5.PBR may make a difference
  • 28. Let’s not be naive about policy change
  • 29. jargon or new reality?
  • 30. the need for entitlements
  • 31. the search for accountability
  • 32. opening up new forms of control
  • 33. I used to work in the fashion design industry as a product developer untilI became ill. This was a hard time in my life. I was diagnosed withparanoid I am now on the road to recovery my budget has reduced. I haveupdated my plan myself and this has given me the opportunity to talkabout what I want for the future. The opportunity to be creative is veryimportant to me and is something that keeps me well. I now receive alittle support and a one off payment which I use to help me to buyequipment to make jewellery. I hope that I will eventually be able toteach other people how to make jewellery to give something back. Mygoal 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 lifeis going, but now I have hopes for the future. I would definitelyrecommend considering a personal budget. You can really make it workfor you in a way that I didn’t know was possible. I feel lucky that I havebeen able to get back some of the life I have lost.From Health Efficiency by Alakeson & Duffy
  • 34. personalised support means...
  • 35. creative support for folk with complex needs
  • 36. 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%
  • 37. the need to change investment patterns
  • 38. integration through personalisation
  • 39. rethinking outcomes LA Resources ‘Social Care’ Well-being?NHS Resources Medical services Clinical outcomes? Improved mentalWelfare funding ‘what works’ health
  • 40. Rethinking commissioning • 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
  • 41. Localism anyone?
  • 42. 4. Don’t get mad, get even
  • 43. WomenCentre:1.Start with the whole woman - gendered and holistic2.Offer a positive and comprehensive model of support - every woman is a one- stop-shop3.Build a bond of trust - create the means for woman to do real work together
  • 44. A positive model of service...5 and 1/2 levels of support
  • 45. Knitting together the bond of trust
  • 46. The future social worker?
  • 47. Time to Campaign?
  • 48. Fund Life
  • 49. 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...
  • 50. You can get much moreinformation on all these You can also jointopics FREE at #FairSocietySubscribe and Follow These slides are © Simon Duffy 2012 ■ Publisher is The Centre for Welfare Reform ■ Slides can be distributed subject to conditions set out at