Mental Health Reform
Self-Directed Support, WomenCentre & Peer Support
Dr Simon Duffy ■ The Centre for Welfare Reform ■ 7th...
The Centre for Welfare Reform
• Welfare state is good - it is just
designed wrong.
• We need to move from meritocratic
pat...
1. Self-directed support works really well in mental
health but has been slow to take off.
2. Working with women, as whole ...
4
1. Self-directed
support
5
6
7
We spend people’s money for
them on things they wouldn’t
really buy for themselves
8
I used to work in the fashion design industry as a product developer
until I became ill. This was a hard time in my life. ...
10
11
Transportation 13% Crafts 2%
Computers and accessories 12% Licenses/ certification 2%
Dental services 11% Entertainment 2%...
13
14
Support needs to fit the person, not the reverse
15
16
IT’S NOT ABOUT SPENDING MONEY - ITS ABOUT LIFE
17
18
2. WomenCentre
19
20
Mental illness intersects with many other social problems
21
There are lots of services, but...
22
Managing a serious health condition 64%
Finding a safer place to live 27%
Living with childhood abuse 51%
Didn’t finish th...
The multiple reinforcing erosion of personal resilience
Mental illness is linked to real poverty
24
25
26
Knitting together the bond of trust
27
Service label n Urgent problem n Real need n
Victim of
domestic violence
55 Debt 50 Better self-esteem 64
Mentally Ill 39 ...
1. Start with the whole woman - gendered and holistic
2. Offer a positive and comprehensive model of
support - every woman ...
3. Self help
30
31
Peer support is critical and will guide us to better solutions
32
“Don't forget to tell them that we had our first PFG
camping trip last Sunday - it was amazing... we are
planning Mad Fest...
34
The future professional?
35
36
4. Social justice
37
1. Income inequality
2. Debt
3. Stigma
4. Multiple social problems
5. Real poverty
If mental illness is an illness is
soci...
39
Income inequality is correlated with mental illness
40
45% of people in debt have mental health problems compared
to 14% of people who are not in debt
Developing unmanageable de...
Chick Collins on the ‘Scottish Effect’
Social stigma is correlated with mental illness
42
43
44
45
1. Human Rights - Better fundamental legislation
2. Clear Entitlements - Its‘my budget’
3. Avoid Crisis - Family support, ...
5. Mental health
reform
47
1. Where is the recognition of the social justice
factors that impact on mental health?
2. Can we be confident in the effec...
49
These findings [better long-term outcomes for schizophrenia in
developing countries] still generate some professional cont...
Rather than reducing inequalities itself, the initiatives aimed at
tackling health or social problems are nearly always at...
Many treatments lack supporting clinical evidence
http://clinicalevidence.bmj.com
52
53
We often create more crises by inappropriate responses
54
Annually, there are 10,000 people placed out of area for
mental health reasons and approximately 11,000 people
with learni...
1. Peer support
2. Personalised support
3. Relationship work
4. Entitlements and control
5. A focus on supporting citizens...
Fund Life,
not services.
...there is a role for
services - but in an
equal partnership
with people and
communities
57
58
For more information:
Web: www.centreforwelfarereform.org
Twitter: @CforWR and @simonjduffy
Blog: www.simonduffy.info
Facebo...
We are wanting to identify and share peer
support innovations that are currently being
developed or are operating in WA. I...
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Mental Health Reform - self-directed support, WomenCentre & peer supportt

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Slides for WAAMH on elements of a reformed mental health system. An exploration of practical innovations - self-directed support, WomenCentre and PFG's peer support system. The presentation goes on to consider the challenges of social justice and system change in mental health.

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Mental Health Reform - self-directed support, WomenCentre & peer supportt

  1. 1. Mental Health Reform Self-Directed Support, WomenCentre & Peer Support Dr Simon Duffy ■ The Centre for Welfare Reform ■ 7th October 2013 ■ Perth, WA ■ Western Australia Association for Mental Health (WAAMH) 1
  2. 2. The Centre for Welfare Reform • Welfare state is good - it is just designed wrong. • We need to move from meritocratic paternalism, and instead respect human diversity & equality • New thinking must promote justice, citizenship, family & community. • Innovate to build practical alternatives 2
  3. 3. 1. Self-directed support works really well in mental health but has been slow to take off. 2. Working with women, as whole women, through relationships also works. 3. Peer support (not just peer support workers) has a tremendous impact. 4. Mental health is at least partly caused by social justice. 5. The future of mental health is to fund life, not services. 3
  4. 4. 4
  5. 5. 1. Self-directed support 5
  6. 6. 6
  7. 7. 7
  8. 8. We spend people’s money for them on things they wouldn’t really buy for themselves 8
  9. 9. I used to work in the fashion design industry as a product developer until I became ill. This was a hard time in my life. I was diagnosed with paranoid schizophrenia... ...as I am now on the road to recovery my budget has reduced. I have updated my plan myself and this has given me the opportunity to talk about what I want for the future. The opportunity to be creative is very important to me and is something that keeps me well. I now receive a little support and a one off payment which I use to help me to buy equipment to make jewellery. I hope that I will eventually be able to teach other people how to make jewellery to give something back. My goal 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 life is going, but now I have hopes for the future. I would definitely recommend considering a personal budget. You can really make it work for you in a way that I didn’t know was possible. I feel lucky that I have been able to get back some of the life I have lost. From Health Efficiency by Alakeson & Duffy 9
  10. 10. 10
  11. 11. 11
  12. 12. 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% 12
  13. 13. 13
  14. 14. 14
  15. 15. Support needs to fit the person, not the reverse 15
  16. 16. 16
  17. 17. IT’S NOT ABOUT SPENDING MONEY - ITS ABOUT LIFE 17
  18. 18. 18
  19. 19. 2. WomenCentre 19
  20. 20. 20
  21. 21. Mental illness intersects with many other social problems 21
  22. 22. There are lots of services, but... 22
  23. 23. 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% Of 44 women working with WomenCentre: 23
  24. 24. The multiple reinforcing erosion of personal resilience Mental illness is linked to real poverty 24
  25. 25. 25
  26. 26. 26
  27. 27. Knitting together the bond of trust 27
  28. 28. Service label n Urgent problem n Real need n Victim of domestic violence 55 Debt 50 Better self-esteem 64 Mentally Ill 39 Housing 48 To overcome past trauma 54 Criminal 35 Benefits 46 To manage current trauma 51 Poor Mother 33 Health 37 To stop being bullied 50 Misuses Alcohol 24 Rent 32 Guidance 50 Uses Drugs 22 Criminal Justice Advocate 24 Relationship skills 45 Violent 19 Dentistry 8 Mothering skills 26 Chronic Health Condition 16 Others 3 Others 1 28
  29. 29. 1. Start with the whole woman - gendered and holistic 2. Offer a positive and comprehensive model of support - every woman is a one-stop-shop 3. Build a bond of trust - create the means for woman to do real work together 4. Be a new kind of community - women, working together, to improve lives and communities. 29
  30. 30. 3. Self help 30
  31. 31. 31
  32. 32. Peer support is critical and will guide us to better solutions 32
  33. 33. “Don't forget to tell them that we had our first PFG camping trip last Sunday - it was amazing... we are planning Mad Fest which will be our mental health festival for next July.  Music group started and we have our own band... we also now have a community garden. And we have started a partnership with the church to have the church hall to do other crazy things in - we are doing pull up a pew - taking a church seat with us to have a cuppa and a chat about how people are feeling. Just incorporating into a proper company and our Jude is now the Chair of Doncaster CCG's Mental Health Alliance (A woman who didn't leave the house for five years)” 33
  34. 34. 34
  35. 35. The future professional? 35
  36. 36. 36
  37. 37. 4. Social justice 37
  38. 38. 1. Income inequality 2. Debt 3. Stigma 4. Multiple social problems 5. Real poverty If mental illness is an illness is social justice the cure? 38
  39. 39. 39
  40. 40. Income inequality is correlated with mental illness 40
  41. 41. 45% of people in debt have mental health problems compared to 14% of people who are not in debt Developing unmanageable debt is associated with an 8.4% risk of developing a mental health problem compared to 6.3% for people without financial problems (i.e. a third higher) Relative risks for people in debt: alcoholism (2x), drug addiction (4x), suicidal ideation (2x) Professor Martin Knapp, 2012 Tizard Lecture Debt is correlated with mental illness 41
  42. 42. Chick Collins on the ‘Scottish Effect’ Social stigma is correlated with mental illness 42
  43. 43. 43
  44. 44. 44
  45. 45. 45
  46. 46. 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 split 46
  47. 47. 5. Mental health reform 47
  48. 48. 1. Where is the recognition of the social justice factors that impact on mental health? 2. Can we be confident in the effectiveness of medicine to treat mental illness? 3. Can we be confident in the helpfulness of the mental health system? 4. Do we know how often do our crisis responses make things worse? Does our current response to mental illness make sense? 48
  49. 49. 49
  50. 50. These findings [better long-term outcomes for schizophrenia in developing countries] still generate some professional contention and disbelief, as they challenge outdated assumptions that generally people do not recover from schizophrenia and that outcomes for western treatments and rehabilitation must be superior. However, these results have proven to be remarkably robust, on the basis of international replications and 15-25 year follow-up studies. Explanations for this phenomenon are still at the hypothesis level, but include: 1. greater inclusion or retained social integration in the community in developing countries, so that the person retains a role or status in the society 2. involvement in traditional healing rituals, reaffirming community inclusion and solidarity 3. availability of a valued work role that can be adapted to a lower level of functioning 4. availability of an extended kinship or communal network, so that family tension and burden are diffused, and there is often less negatively 'expressed emotion' in the family. Dr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countries learn from Developing Countries? World Psychiatry 2006, 5: 21-24 50
  51. 51. Rather than reducing inequalities itself, the initiatives aimed at tackling health or social problems are nearly always attempts to break the links between socio-economic disadvantage and the problems it produces. The unstated hope is that people - particularly the poor - can carry on in the same circumstances, but will somehow no longer succumb to mental illness, teenage pregnancy, educational failure or drugs. Wilkinson & Pickett, The Spirit Level We ignore the social and economic dimension 51
  52. 52. Many treatments lack supporting clinical evidence http://clinicalevidence.bmj.com 52
  53. 53. 53
  54. 54. We often create more crises by inappropriate responses 54
  55. 55. Annually, there are 10,000 people placed out of area for mental health reasons and approximately 11,000 people with learning disabilities are also placed out of area per year. Nationally, the National Mental Health Development Unit (NMHDU) estimated that out of area placements for mental health cost £690 million per annum, therefore the combined cost of out of are placements is likely to be more than twice that amount, that is over £1.5 billion (NMHDU, 2011). Of the total number of residential and nursing care placements for mental health each year, 22% are out of area. Alakeson and Duffy, Health Efficiencies We move people and money out of communities 55
  56. 56. 1. Peer support 2. Personalised support 3. Relationship work 4. Entitlements and control 5. A focus on supporting citizenship We can see some of the main elements of a reformed mental health system 56
  57. 57. Fund Life, not services. ...there is a role for services - but in an equal partnership with people and communities 57
  58. 58. 58
  59. 59. For more information: Web: www.centreforwelfarereform.org Twitter: @CforWR and @simonjduffy Blog: www.simonduffy.info Facebook: centreforwelfarereform Campaign: www.campaignforafairsociety.org © Simon Duffy. Rights Reserved. Full copyright details at www.centreforwelfarereform.org 59
  60. 60. We are wanting to identify and share peer support innovations that are currently being developed or are operating in WA. If you would like to attend the Peer Support Symposium please subscribe to our newsletter and contact admin@comhwa.org.au www.comhwa.org.au Peer Support Symposium 60

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