Mental Health, Social Inclusion & Co-production

1. Mental Health, Social Inclusion & Co-production David Morris National Social Inclusion Programme

2. Co-production in mental health - a fundamental value - but needs radically realigned thinking: • ‘Community’ does exist and • policy co-constructs it. • People have multiple identities and • we need to engage with them all. • Independence may not trump interdependence.. • Paid work - a very good thing, but not everything.

3. Policy context Policy in MH defined by: • Mental Health Strategy – ‘Modernising Mental Health Services: Safe, Sound and Supportive’ (DH 1998) • National service framework for MH (DH 1999) • Choosing Health (DH 2004) • Improving the life chances of disabled people (DWP, DH, DfES, ODPM 2005) • ‘Our health, Our Care, Our Say’ (DH 2006) • Local Government and Public Involvement Bill (DCLG 2007)

4. Policy context …and for social inclusion in mental health by: • Mental Health and Social Exclusion (Social Exclusion Unit 2004) • Reaching Out: An Action Plan on Social Exclusion(Cabinet Office 2006)

5. Key policy dimensions • Most disadvantaged groups: promoting independent living; improving lives by giving service users more choice and control - self-directed care; individual budgets; Direct Payments • Communities: promoting health and wellbeing in context of the ‘public mental health’ (new commissioning framework published 7.3.07) • All: involving public, patients, service users and carers in planning and delivery of care

6. Policy context …and for social inclusion in mental health by: • Mental Health and Social Exclusion (Social Exclusion Unit 2004) • Reaching Out: An Action Plan on Social Exclusion(Cabinet Office 2006)

7. Published June 2004Office of the Deputy Prime Minister

8. Challenging exclusion - the vision behind the SEU report “Social Inclusion for people with mental health problems is a moral imperative” (Minister for Health, launching SEU report June 04) “Our vision is a future where people with mental health problems have the same opportunities to work and participate in their communities as any other citizen” (SEU Report p94)

9. SEU Project – remit & timescales • How to enable more adults with mental health problems to enter and retain work? • How to enable social participation and access to services? • Feb 2003 to Mar 2004: consultation; - • June 2004: publication • Sept 2004: implementation starts

10. Less than a quarter of adults with mental health problems are in work - the lowest employment rate among disabled people Main barriers • fear of losing benefits • employers’ attitudes • fluctuating nature of condition • low expectations of health professionals

11. Social exclusion has multiple impacts • What can happen when people or areas suffer from a combination of linked problems – unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown. • Characterised by the inter - relatedness of problems that are mutually reinforcing; combined they create a fast moving, complex and vicious cycle. (Social Exclusion Unit 2004)

12. People are excluded in many different ways physical illness overlooked • low levels of participation in • FE/leisure activities harassment complaint not taken seriously not eligible to be juror or school governor financial services hard to access 1/4 tenants with serious arrears at risk of eviction

13. People can become very isolated Outer circle: places where friendships start. Inner circle: People who matter Services Employment      Education   Sport/ exercise Family/ neighbourhood Volunteering Arts and Culture Faith communities Sue attends the day centre and the clinic She has 5 friends she sees at outpatients or the day centre

14. National Social Inclusion Programme • 3 year programme from Sept 04 – 07, based at National Institute for Mental Health in England • National and regional centres • Cross - sectoral; cross - government • National and regional activity in partnership • Linked to public health, mental health promotion, equalities programmes

15. NATIONAL SOCIAL INCLUSION PROGRAMME NATIONAL LEVEL CENTRAL CROSS – GOVERNMENT TEAM REGIONAL LEVEL 8 DEVELOPMENT CENTRES – Social Inclusion leads SE SW LON EM NE,Y&H NW WM E STIGMA/ DISCRIM’ ION EMPLOY- MENT INCOME/ BENEFITS EDUC’N HOUSING CTT’Y PARTIC’N SOCIAL NETW’KS DIRECT PAYM’TS Cross cutting work streams: Workforce Development - Research & Evidence - Community Engagement - Criminal Justice - Inequalities AFFILIATES NETWORK: 50 organisations - users, voluntary, professional

16. Community Participation Day service modernisationis key component Refocusing Day Services: • traditional day services provide specialist support solely for those with mental health problems in a segregated day facility • traditional day services often fail to meet the diverse needs of the community they serve • being in work and having social contacts is strongly associated with improved health and well-being

17. Day service modernisation - three more policy documents • ‘From segregation to Inclusion’: • Commissioning guidance on day services for people with mental health problems • Supporting women into the mainstream: • Commissioning women-only community day services • Direct Payments for people with mental health problems - a guide to action (all NSIP 2005)

18. Day service modernisation Modernised approach achieves 4 goals: • Opportunities for social contact and support • Support to retain existing roles, contacts, activities. • Support to access new roles, relationships, activities. • Opportunities for service users to run their own services and provide their own support All better achieved with co-production and community bridge building in mind!

19. NSIP influencing widely across sectors& engaging communities ‘Together we can improve our health and well-being … … What will be done: Tackle the social exclusion experienced by people with mental health problems by bringing together local communities and citizens with mental health needs in partnership with the relevant public services ‘Together We Can’ (2005) Strategy for Community Engagement, Home Office, Civil Renewal Unit

20. Co-production means… linking governance to social capital through realistic approaches to community engagement: ‘Rather than expect everyone to participate equally in formal governance, we should try to make more people’s everyday civic engagement count by designing the formal governance in a way that taps into the informal spaces of community life that they routinely inhabit.’ Community Participation, Who benefits? (2006) Skidmore, P. Bound, K. Lownsbrough, H. Joseph Rowntree Foundation

21. The informal spaces of community life that people routinely inhabit The places with which people are already familiar – the … newsagent or post office hold the key to engaging them in governance activity. These places and the organisations that occupy them act as the everyday bridge between ordinary people and more formal governance activities. Participation, Who benefits? (2006) Skidmore, P. Bound, K. Lownsbrough, H. Joseph Rowntree Foundation

22. ‘The places with which people are already familiar …. …also the setting for co-produced services?

23. Thank you www.socialinclusion.org.uk david.morris@dh.gsi.gov.uk