Mental health is better supported through community and citizenship rather than services alone. Current systems focus too much funding on services instead of improving social inclusion. Personalized support and strengthening communities could lead to better long-term mental health outcomes compared to traditional treatment models.

1. Mental Health
Local 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. 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

5. ese 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outdated assumptions that generally people do not recover from schizophrenia and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 oen 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

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 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%

9. An alternative hypothesis - poor mental
health is a function of real poverty.
The multiple reinforcing erosion of personal

11. Urgent
Service label N N Real need N
problem
Victim of Better self-
domestic 55 Debt 50 64
esteem
violence
To overcome
Mentally Ill 39 Housing 48 54
past trauma
To manage
Criminal 35 Benefits 46 51
current trauma
To stop being
Poor Mother 33 Health 37 50
bullied
Misuses 24 Rent 32 Guidance 50
Alcohol
Criminal Justice Relationship
Uses Drugs 22 24 45
Advocate skills
Violent 19 Dentistry 8 Mothering skills 26
Chronic Health
16 Others 3 Others 1
Condition

12. WomenCentre:
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,

14. A positive model of service...
...5 and half levels of support

15. Knitting together the bond of trust

16. “Working with” - real wealth

21. 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%
cessation
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%

28. I used to work in the fashion design industry as a product developer until I became ill. is was a
hard time in my life. I was diagnosed with paranoid schizophrenia and spent a year in hospital. When
I came out of hospital, I moved into supported living and had some help from the Mental Health
Recovery Team who were fantastic at supporting me to have the skills I need to be well. I now live in
my own place.
I was offered a personal budget and had support to write a plan that said what I was going to spend
my budget on to help me meet my assessed needs. At first I used my budget to purchase some support
from an agency, which helped me to regain some of my confidence.I’ve now had a personal budget for
a few years. It helps me to feel happy again and gives me some confidence to keep moving forwards. It
feels 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 this
has given me the opportunity to talk about what I want for the future. e 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

31. Local Authority Well-being or
‘Social Care’
Resources Independence
Improved clinical
NHS Resources Medical services
outcomes
Welfare Improved mental
‘what works’
funding health

32. • 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

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