Innovation in a Backwater: the Harpurhey Resettlement Team and the Mental Health Services of North Manchester, 1982–1987

View metadata, citation and similar papers at core.ac.uk ARTICLE IN PRESS brought to you by CORE provided by Elsevier - Publisher Connector Health & Place 15 (2009) 664–671 Contents lists available at ScienceDirect Health & Place journal homepage: www.elsevier.com/locate/healthplace Innovation in a backwater: The Harpurhey Resettlement Team and the mental health services of North Manchester, 1982–1987 Val Harrington Personal Social Services Research Unit, Dover St. Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK article i nfo abstract Article history: This paper explores the circumstances around the setting up of the Harpurhey Resettlement Team, an Received 3 February 2009 innovative project which, in the late 1980s, resettled around 20 long-stay patients from Springfield Accepted 3 February 2009 Hospital in North Manchester into ordinary tenancies within the same neighbourhood. It argues that Springfield’s position as a marginalised and neglected institution produced the conditions for such Keywords: innovation; while the particular and unexpected convergence of national policies, local structures and Mental health services institutional politics created space for a process of change which, in both form and outcome, could not History have occurred in the more regulated psychiatric environments elsewhere in Manchester. Innovation & 2009 Elsevier Ltd. Open access under CC BY license. Introduction which this paper is based was highly unusual—and, indeed, in terms of both origin and intent, represented a fundamental y So I got to know I can’t remember if it was two people challenge to the prevailing models of both mental illness and 1 or one person, but the person I remember is Winifred, mental illness services. who was a woman living in Springfield, on a ward in The service in question was the Harpurhey Resettlement Team Springfield, and as part of the ‘Getting to Know You’ process which, in the late 1980s, resettled between 20 and 25 long-stay we had to be with them in the hospital, had to be with them patients from Springfield Hospital in North Manchester. The outside and then after that we had to read the notes. But it was project differed from traditional resettlement programmes in a [pause] it made the planning process into a very personal number of key ways. Firstly, the accommodation took the form of thing, which was .. which was wonderful. You know, it wasn’t ordinary tenancies—individually rented flats and houses as about just some group of people over there, you became opposed to the more usual pattern of hostels, group homes and attached to this particular person and wanted to make the plan sheltered housing schemes. Secondly, the whole project was built work for them. around the notion of neighbourhood. The entire cohort moved to (Interview 1: Research Assistant, Getting to Know You Project) the same geographical district, a small, well-established neighbourhood of approximately one square mile in area, and from the The above quotation provides an unusual introduction to a beginning the focus was as much on developing links with the paper which is essentially about service development. Firstly, the local community as on clinical practice—something which was speaker—a young Cambridge graduate, working initially as a underlined both by the presence of an experienced community volunteer and later on a temporary research contract funded by development worker in the team and by the fact that a significant the Manpower Services Commission—is not a figure one would proportion of support workers were appointed on the basis of normally associate with strategic service planning. Secondly, their connections with the area, rather than any direct mental neither his language nor tone is typical of someone engaged in health experience. Thirdly, despite this broad range of personnel, the purportedly rational and objective activity of service design. skills and backgrounds, the team structure was explicitly non- And thirdly, establishing a deeply personal relationship with an hierarchical, with no team leader, decision-making by consensus, elderly woman, incarcerated on a psychiatric backward for the skill-sharing and, in the early stages, broad parity between the past 40 years, is hardly the starting point most planners would support workers in terms of both pay and job descriptions. Given choose for developing new ways of delivering mental health that half the support workers were qualified psychiatric nurses services to the local community. But then, the service around employed by the health authority, and half were social services workers who were mainly unqualified, local people, this latter feature was particularly unusual—as, indeed was the fact that the E-mail addresses: [email protected], [email protected] (V. Harrington). project was jointly managed by health and social services. Finally, 1 The name has been changed to preserve patient confidentiality. the team was closely involved with radical mental health issues 1353-8292/& 2009 Elsevier Ltd. Open access under CC BY license. doi:10.1016/j.healthplace.2009.02.008 ARTICLE IN PRESS V. Harrington / Health & Place 15 (2009) 664–671 665 and organisations, and played a part in the setting up of the economy of welfare’, characterised, according to Rogers and independent and highly vocal North Manchester Users’ Group.2 Pilgrim (2001), by the triple themes of ‘privatisation, market- The focus of this paper will be on the setting up of the service: isation and managerialism’. The other side of Thatcherism was the the context, both national and local, within which it developed; huge wave of opposition that her policies fuelled and the new the drivers and mediators of change; and the mechanisms and generation of left wing activism they spawned. At a local level this processes involved. Clearly, the actual number of patients opposition took a particularly interesting form, with the springing resettled by the team represents only a small proportion of the up of loose networks of likeminded people, mobilising around hospital’s several hundred long-stay population. In symbolic specific issues and projects. A significant proportion involved the terms, however, the project was hugely significant, occupying a reframing of traditional health or welfare issues within a broader, central position in the massive political upheavals which left wing agenda, and the drawing in of actors and resources from accompanied the transfer of services away from the old mental a range of backgrounds and perspectives—influencing services in hospital into new settings. As such, the case study provides a ways which had not been predicted and creating and fostering fascinating window through which to explore the dynamics of strong links across various sectors and levels of service. These change and, more specifically, to trace the interplay between the links were to prove pivotal both in this story, and more generally national and the local: not only how national policies were in the increasingly complex and fluid world of the late twentieth implemented and interpreted on the ground but also how broader century British health and welfare services. social and political themes were played out within the context of local service development. Within this, the notion of place plays a The mental health context: deinstitutionalisation and mental health central role: firstly, in relation to the actual service model; activism secondly, in terms of Springfield itself and the ways in which its very particular history and geography created the conditions for Speaking personally, I felt that there were three currents, three non-mainstream forms of innovation; and thirdly, echoing strands that were going. One was the ‘Survivors Speak Out’3 Spandler’s notion of ‘convergent space’, as a particular ‘place in stuff, so it’s actually service users’ autonomous voice work that time’, in which a unique—and in this instance often contra- was comingythe second one was very much our strand, which dictory—combination of political forces and social actors came was the resettlement programme, because it wasn’t just us, it together in one ‘specific, local convergent site’ (Spandler, 2006, was happening across the UKyAnd then the third one is p. 23). theylegacy of people like Laing and so on, Cooper,4 so people My sources are predominantly oral, drawn from interviews who had set up alternative, counter-therapy type.. therapeutic with practitioners and service providers which have been communitiesy and it was that melange of the three that I conducted over the past 3 years as part of my PhD, a broader felt..heady days. post-war history of mental health services in Manchester and (Interview 2: Nurse on the Harpurhey Resettlement Team) Salford (Harrington, 2008). Recruited largely through the ‘snow- balling’ technique (Crossley, 2006), my 22 North Manchester informants represent a range of perspectives and occupational Within this broader context of economic and public service backgrounds: from key figures within the services to frontline reform the mental health services were facing their own workers; from the drivers of innovation to those who were particular pressures, brought on by an accelerating programme required to adapt and implement the changes within their day- of deinstitutionalisation. The run down of the large mental hospitals had been firmly on the agenda since Enoch Powell’s to-day practice; and from opponents as well as advocates of 5 change. What is clearly missing is the voice of service users. This is famous ‘water tower’ speech of 1961, but progress over the due to the constraints of both time and space and reflects how, subsequent two decades had been slow and gradual. In 1975, for with a primary focus on service dynamics and organisational example, the Government White Paper, Better Services for the issues, staff rather than patients were the natural target group. Mentally Ill, had highlighted how, although mental hospital The oral testimonies are augmented by documentary evidence in populations were falling, levels had not yet halved and no the form of reports, minutes and service materials.

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