Personalisation & Mental Health


Published on

Logically personalisation and mental health are in perfect harmony - the fact that progress is so slow reflects deep imbalances of power, control and perception.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Personalisation & Mental Health

  1. 1. Personalisation & mental health exploring key ideasDr Simon Duffy - The Centre for Welfare Reform - UCLAN & Mind - Manchester - 19 March 2013
  2. 2. Dr Simon Duffy•Social innovator - e.g. personal budgets•Philosopher - work on citizenship•Advisor - Campaign for a Fair SocietyThe Centre for Welfare ReformReform does not mean cutsand inequalityWelfare state is good, but designedwrongNeeds more innovation, andRespect for citizenship,families, community & justice•Reform does not mean cuts and inequalityWelfare state isgood, but designed wrongNeeds more innovation,andRespect for citizenship, families, community & justice
  3. 3. Ideology: grassroots to mainstream & beyondThe development of personalisation theory andrelevance to policy development and wider healthand social care practice will be discussed. Theinterplay between economic need for reform andmarket development will be explored and itssignificance to mental health service users andlocal service and support provision discussed. and market development will be explored and itssignificance to mental health service users andlocal service and support provision discussed.
  4. 4. Know how to take things. Neveragainst the grain, though they’rehanded to you that way. There aretwo sides to everything. If you grabthe blade, the best thing will do youharm; the most harmful will defendyou if you seize it by the hilt.Baltasar Gracian
  5. 5. “...the standard of justice depends on theequality of power to compel and that in factthe stronger do what they have the power todo and the weak accept what they have toaccept.”cited by Thucydides
  6. 6. Key points1.Personalisation is ‘contested’2.Mental health reform has been slow3.Problems are going to grow4.Change may yet come
  7. 7. 1. Personalisation
  8. 8. I used to work in the fashion design industry as a product developeruntil I became ill. This was a hard time in my life. I was diagnosedwith paranoid I am now on the road to recovery my budget has reduced. Ihave updated my plan myself and this has given me the opportunityto talk about what I want for the future. The opportunity to becreative is very important to me and is something that keeps mewell. I now receive a little support and a one off payment which Iuse to help me to buy equipment to make jewellery. I hope that Iwill eventually be able to teach other people how to make jewelleryto give something back. My goal is to start up my own jewellerybusiness and be financially self-supporting, and the recovery team ishelping me with this.Without the support that I have I would still be wondering where mylife is going, but now I have hopes for the future. I would definitelyrecommend considering a personal budget. You can really make itwork for you in a way that I didn’t know was possible. I feel luckythat I have been able to get back some of the life I have lost.From Health Efficiency by Alakeson & Duffy
  9. 9. Citizenship Theoryby Duffy
  10. 10. Keys to Citizenship
  11. 11. Citizenshipis the key1.Purpose - a life of meaning2.Freedom - directing my own life3.Money - having enough on which to build4.Home - being where I belong5.Help - that fits me6.Life - getting stuck in7.Love - getting it and giving it
  12. 12. Murray’s Real Wealth Model
  13. 13. 2. Mental health
  14. 14. Erving Goffmans Asylums (1960) arose out the time he spentin 1955-56 at St Elizabeths Hospital Washington DC, wherehe observed at first hand the daily life of mental patients andstaff. he concluded that in the total institution that asylumwas, doctors and patients were bound together in amasquerade in which the first had to behave in authoritarianfashion while the second enacted variations on the themes ofmanic craziness: even if power lay with the doctors, bothcolluded in a social order which perpetuated madness ratherthan the vaunted and hoped-for cure.From Mad, Bad and Sad by Lisa Appignanesi
  15. 15. • 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
  16. 16. These findings [better long-term outcomes for schizophrenia indeveloping countries] still generate some professional contention anddisbelief, as they challenge outdated assumptions that generally peopledo not recover from schizophrenia and that outcomes for westerntreatments and rehabilitation must be superior. However, these resultshave proven to be remarkably robust, on the basis of internationalreplications and 15-25 year follow-up studies. Explanations for thisphenomenon are still at the hypothesis level, but include:1. greater inclusion or retained social integration in the community indeveloping countries, so that the person retains a role or status in thesociety2. involvement in traditional healing rituals, reaffirming communityinclusion and solidarity3. availability of a valued work role that can be adapted to a lower levelof functioning4. availability of an extended kinship or communal network, so thatfamily tension and burden are diffused, and there is often less negativelyexpressed emotion in the familyDr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countries learn fromDeveloping Countries? World Psychiatry 2006, 5: 21-24
  17. 17. Government doesn’t always know best[The ill-fated Pruitt- Igoe housing project]
  18. 18. 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%
  19. 19. Lots of services,no supportno support
  20. 20. Our hypothesisPoor mental health is a function of real povertyMultiple reinforcing erosion of personal resilience
  21. 21. Service label N Urgent problem N Real need NVictim of domesticviolence 55 Debt 50 Better self-esteem 64Mentally Ill 39 Housing 48 To overcome past trauma 54Criminal 35 Benefits 46 To manage current trauma 51Poor Mother 33 Health 37 To stop being bullied 50Misuses Alcohol 24 Rent 32 Guidance 50Uses Drugs 22 Criminal Justice Advocate 24 Relationship skills 45Violent 19 Dentistry 8 Mothering skills 26Chronic HealthCondition 16 Others 3 Others 1
  22. 22. 3. Crises
  23. 23. The relative risk by different environments
  24. 24. We spend people’s money forthem on things they wouldn’t really buy for themselves
  25. 25. • 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
  26. 26. Mental health will deteriorate as1.Inequality will increase2.Stigmatisation will increase3.Real poverty will increase
  27. 27. Income inequality correlated with mental illness
  28. 28. 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 health problemcompared to 6.3% for people without financialproblems (i.e. a third higher)Relative risks for people in debt: alcoholism (2x),drug addiction (4x), suicidal ideation (2x)Martin Knapp, 2012 Tizard Lecture
  29. 29. Some of this may be caused by psychologicalaspects of poverty, e.g. stigma: Chick Collins on the ‘Scottish Effect’
  30. 30. 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 and theproblems it produces. The unstated hope is thatpeople - particularly the poor - can carry on in thesame circumstances, but will somehow no longersuccumb to mental illness, teenage pregnancy,educational failure or drugs.Wilkinson & Pickett, The Spirit Level
  31. 31. 4. Reforms
  32. 32. 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
  33. 33. Not gifts, but entitlements
  34. 34. creative support for folk with complex needs
  35. 35. personalised support means...
  36. 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. 37. integration through personalisation
  38. 38. the need to change investment patterns
  39. 39. rethinking outcomesLA Resources ‘Social Care’ Well-being?NHS Resources Medical services Clinical outcomes? Improved mentalWelfare funding ‘what works’ health
  40. 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. 41. Localism anyone?
  42. 42. 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, working together, to improve lives and communities.
  43. 43. A positive model of service...5 and 1/2 levels of support
  44. 44. Knitting together the bond of trust
  45. 45. Personalisation Forum Group
  46. 46. The future social worker?
  47. 47. Time to Campaign?
  48. 48. Fund Life
  49. 49. The victorious ‘Fabians’We have little faith in the average sensual man,we do not believe that he can do more thandescribe his grievances, we do not think he canprescribe the remediesBeatrice Webb
  50. 50. The defeated ‘Distributivists’We say there ought to be in the world a greatmass of scattered powers, privileges, limits, pointsof resistance, so that the mass of Commons mayresist tyranny. And we say that there is apermanent possibility of that central direction,however much it may have been appointed todistribute money equally, becoming a tyranny.G K Chesterton
  51. 51. Honour can existanywhere,love can existanywhere,but justice can existonly among peoplewho found theirrelationships upon it.Ursula Le Guin
  52. 52. 1. Human Rights - Better fundamental legislation2. Clear Entitlements - Its ‘my budget’3. Avoid Crisis - Family support, lowerthresholds4. Full Access - No ‘special’ funding for services5. Choice & Control - Freedom, capacity6. Fair Incomes - Enough for citizenship7. Fair Taxes - No ‘special taxes’, no charges8. Sustainability - Rethink health/social care split
  53. 53. If you want to get more involved1.Join the Campaign for a Fair Society www.campaignforafairsociety.org1.Subscribe to The Centre for Welfare Reform www.centreforwelfarereform.org1.Twitter users can follow #fairsociety