Working for Inclusion ARTWORK J
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Working for Inclusion Making social inclusion a reality for people with severe mental health problems Edited by Peter Bates Working for Inclusion Making social inclusion a reality for people with severe mental health problems Edited by Peter Bates © The Sainsbury Centre for Mental Health 2002 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise without the prior permission of the publisher. Photography Photos supplied by kind permission of: Active Outreach Team, Julian Housing Bromley-by-Bow Centre [photography by Jon Walter] NIACE – National Organisation for Adult Learning [photography by Nick Hayes] Oxfordshire Mental Health Matters Pentreath Industries Ltd [photography by Neale & Neale] ISBN: 1 870480 54 6 Published by The Sainsbury Centre for Mental Health 134–138 Borough High Street London SE1 1LB Tel: 020 7827 8300 Fax: 020 7403 9482 www.scmh.org.uk The Sainsbury Centre for Mental Health is a registered charity, working to improve the quality of life for people with severe mental health problems. It aims to influence national policy and encourage good practice in mental health services, through a co-ordinated programme of research, training and development.The Centre is affiliated to King’s College London (School of Health and Life Sciences). Charity registration number 291308 Contents Introduction How to use this resource . 1 A note from the editor . 3 Setting the scene . 5 Section One Defining things Introduction . 9 Defining inclusion . 11 Defining community. 15 Defining community development . 21 Defining inclusive mental health services . 29 Section Two Inclusion as a new paradigm Introduction . 35 Politics and social exclusion . 37 Partnerships for inclusion . 45 Beyond hospital closure . 51 Mental health promotion. 57 Civil rights . 71 Section Three Inclusion in the whole of life Introduction . 79 Growing strong communities . 83 Community safety . 91 Housing . 101 The information age . 113 Education . 123 Employment . 131 Employment project profile . 139 iii Section Four Working for inclusion Introduction . 147 Primary care . 151 Primary care – a collaborative approach . 155 Early intervention . 163 Acute care . 171 Long term support . 179 Section Five Evaluation Introduction . 187 User-led research . 189 The European Union . 197 A framework . 203 Social capital and social networks . 211 Assessing individual needs . 223 Section Six Modernising services Introduction . 227 Some practical resources . 229 Person-centred planning . 239 Transforming the whole organisation . 253 Power . 261 List of contributors . 265 References . 269 iv Introduction: HOW TO USE THIS RESOURCE This publication has been written to help the users and staff of mental health services think about citizenship and social inclusion. It is also written for people who live and work in other areas of the community and share our concern to ensure that people with mental health difficulties get a fair deal. As a starting point Each section discusses an aspect of social inclusion and citizenship and its relationship to mental health and comprises an introduction and a number of articles.The processes of social inclusion are complex and relatively untried.There is to date no list of simple instructions on how to ‘do’ it. However, this publication provides many starting points for discussion and action. Although the contributions are arranged in a logical order, there are many relationships between the different sections. For example, the topic of mental health promotion is discussed in Section Two, but also appears in Section Three and Four. It is the nature of social inclusion that issues cannot be easily compartmentalised. Responding to issues raised Individual articles can be circulated to interested people for consideration. Key points for consideration appear at the end of each article.You may wish to bring together a group of people in your locality to discuss your responses to the issues raised. The language of mental health Words matter.Traditionally, those in power have used that power to define and name the experiences of others with words such as patients, psychiatric illness, acute treatment and rehabilitation. More recently, some individuals have reclaimed the territory with the Working for Inclusion © THE SAINSBURY CENTRE FOR MENTAL HEALTH, 2002 1 Introduction HOW TO USE THIS RESOURCE ordinary language of distress, crisis, survival, recovery and pride. Many writers have contributed to this publication and in doing so have used a variety of different terms. Rather than try to create a superficial consistency, these different words have been left in the text. Everyone has tried to write respectfully. The use of examples When examples are given in a publication of this kind, it can be misleading. People might assume the example is the best that anyone can do.The examples used are, in fact, the most interesting that we could find, but there may well be a number of much better projects in your locality. Some people may assume that the project example is a recipe for success and try to photocopy the detail onto their own environment. Others may be tempted to point to what they perceive are the shortcomings of these ‘flagship’ projects, and ignore any lessons that are to be learnt.We hope that readers will look beyond the detail to the ideas, values and the goals that these projects espouse. 2 © THE SAINSBURY CENTRE FOR MENTAL HEALTH, 2002 Working for Inclusion Introduction: A NOTE FROM THE EDITOR Peter Bates One of New Labour’s projects since coming into power has been the creation of a Social Exclusion Unit, responsible for tackling social exclusion across government departments. They have described social exclusion as “… a shorthand label for what can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environment, bad health and family breakdown.” (Social Exclusion Unit, 1999) A glance at the tabloid newspapers will show that this exploration is being undertaken in an environment that is often ambivalent and sometimes hostile. Media statements often emphasise the need to protect the community from people with mental health problems, promise zero tolerance towards homeless people, reinforce negative stereotypes of asylum seekers and make murderous threats against sex offenders. The proposed revision of the Mental Health Act 1983 strengthens powers to restrict the freedom of people with mental health problems who live in the community. In contrast, education, health and employment action zones, economic and community regeneration and a whole range of other government initiatives have been established with the explicit aim of combating social exclusion. A wide range of evidence showing how people with experience of mental distress are subject to exclusion has been gathered over the past decade, culminating in the Mind Inquiry (Dunn, 1999). Some new local projects have sprung up in response to the focus on inclusion, while others have recognised that their longstanding programmes have been tackling social exclusion under other names. Despite these initiatives, we have a sense that social inclusion and citizenship are either ignored or ‘bolted on’ to the existing mental health agenda.We wanted to look at the whole task of mental health services through the lens of inclusion.What issues would be raised? What would projects, care plans and performance indicators look like? The more work we gathered together, the more it became clear that social inclusion was not merely an attractive goal for mental health services – it was imperative. Working for Inclusion © THE SAINSBURY CENTRE FOR MENTAL HEALTH, 2002 3 Introduction A NOTE FROM THE EDITOR Social inclusion is both new and old. It is as old as the effort to build a vibrant community, as old as the struggle to transform a stultifying bureaucracy, as old as the search for ways to harness each person’s potential. But there is new work to do.When friendships grow between mental health organisations and unlikely partners, such as museums, faith communities or business start-up agencies, all sorts of problems arise for which the policy handbook on the shelf has no ready-made answer. New work is needed to keep up with the aspirations of service users and creative staff who are eager to endorse and sponsor service users in voting, working and banking in the community. This publication is not meant to be the last word in citizenship, social inclusion and mental health.The contributors have shared their perspectives and experiences on this emerging topic. In a year’s time, some of them would want to write a very different article, as they grow in experience and plug some of the gaps in their personal understanding.We hope that it will stimulate a flurry of responses, inquiries, publications and most of all, improved practice. Peter Bates National Development Team 4 © THE SAINSBURY CENTRE FOR MENTAL HEALTH, 2002 Working for Inclusion Introduction: SETTING THE SCENE David Morris It is a great pleasure to introduce this resource on behalf of the Sainsbury Centre for Mental Health and six national partner agencies – Community Development Foundation, Disability Rights Commission, mentality, Mental Health Foundation, Mind, and the National Development Team. This publication is one practical outcome of the Citizenship and Community Programme, a major national initiative on social inclusion,