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(181) mh & primary care (september 2011)


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(181) mh & primary care (september 2011)

  1. 1. Mental HealthLocal and Personal Vs. Central and Institutional by Dr Simon Duffy of e Centre for Welfare Reform, for University of Birmingham’s Health Service Management Centre Seminar on 23rd September 2011
  2. 2. my 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
  3. 3. ese findings [better long-term outcomes for schizophrenia in developingcountries] still generate some professional contention and disbelief, as they challengeoutdated assumptions that generally people do not recover from schizophrenia andthat outcomes for western treatments and rehabilitation must be superior. However,these results have proven to be remarkably robust, on the basis of internationalreplications and 15-25 year follow-up studies. Explanations for this phenomenon arestill at the hypothesis level, but include:1. greater inclusion or retained social integration in the community in developingcountries, so that the person retains a role or status in the society2. involvement in traditional healing rituals, reaffirming community inclusion andsolidarity3. availability of a valued work role that can be adapted to a lower level of functioning4. availability of an extended kinship or communal network, so that family tensionand burden are diffused, and there is oen less negatively expressed emotion in thefamilyDr Alan Rosen from Destigmatising day-to-day practices: What Can DevelopedCountries learn from Developing Countries? World Psychiatry 2006, 5: 21-24
  4. 4. 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 have 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%
  5. 5. An alternative hypothesis - poor mentalhealth is a function of real poverty. The multiple reinforcing erosion of personal
  6. 6. UrgentService label N N Real need N problemVictim of Better self-domestic 55 Debt 50 64 esteemviolence To overcomeMentally Ill 39 Housing 48 54 past trauma To manageCriminal 35 Benefits 46 51 current trauma To stop beingPoor Mother 33 Health 37 50 bulliedMisuses 24 Rent 32 Guidance 50Alcohol Criminal Justice RelationshipUses Drugs 22 24 45 Advocate skillsViolent 19 Dentistry 8 Mothering skills 26Chronic Health 16 Others 3 Others 1Condition
  7. 7. 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 together4. Be a new kind of community - women,
  8. 8. A positive model of service... ...5 and half levels of support
  9. 9. Knitting together the bond of trust
  10. 10. “Working with” - real wealth
  11. 11. 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 5% Education, training, materials 1%cessationUtilities 3% Haircut, manicure etc. 1%Travel 3% Pet ownership 1%Equipment 3% Supplies and storage <1%Clothing 2% Other <1%Food 2% Total 100%
  12. 12. I used to work in the fashion design industry as a product developer until I became ill. is was ahard time in my life. I was diagnosed with paranoid schizophrenia and spent a year in hospital. WhenI came out of hospital, I moved into supported living and had some help from the Mental HealthRecovery Team who were fantastic at supporting me to have the skills I need to be well. I now live inmy own place.I was offered a personal budget and had support to write a plan that said what I was going to spendmy budget on to help me meet my assessed needs. At first I used my budget to purchase some supportfrom an agency, which helped me to regain some of my confidence.I’ve now had a personal budget fora few years. It helps me to feel happy again and gives me some confidence to keep moving forwards. Itfeels different because previously I had services organised for me.As I am now on the road to recovery my budget has reduced. I have updated my plan myself and thishas given me the opportunity to talk about what I want for the future. e opportunity to be creativeis very important to me and is something that keeps me well. I now receive a little support and a oneoff payment which I use to help me to buy equipment to make jewellery. I hope that I will eventuallybe able to teach other people how to make jewellery to give something back. My goal is to start up myown jewellery business and be financially self-supporting, and the recovery team is helping me withthis.Without the support that I have I would still be wondering where my life is going, but now I havehopes for the future. I would definitely recommend considering a personal budget. You can reallymake it work for you in a way that I didn’t know was possible. I feel lucky that I have been able to getback some of the life I have lost.From Health Efficiency by Alakeson & Duffy
  13. 13. Local Authority Well-being or ‘Social Care’ Resources Independence Improved clinicalNHS Resources Medical services outcomes Welfare Improved mental ‘what works’ funding health
  14. 14. • Total place - e Humpty- Dumpty challenge• Buy local - individuals, communities and local organisations• Innovate - you can’t move without changing• Measure - focus on what really matters
  15. 15. The Centre for Welfare ReformThe Quadrant, 99 Parkway Avenue,Parkway Business ParkSheffield, S9 4WGT +44 114 251 1790 | M +447729 7729 41admin@centreforwelfarereform.orgGet a free subscription at:© Simon Duffy. Rights Reserved. Full copyright details at