Editorial

Editorial

Article Type: Editorial From: Mental Health and Social Inclusion, Volume 19, Issue 3.

Julie Repper and Rachel Perkins

The rightful role of mental health services

"Recovery" as we understand it was not conceived, defined or aspired to by health professionals but by people who experienced the challenges of mental health conditions. Like us, these people continued to experience distressing, distracting, at times comforting and strengthening - and at other times disturbing - symptoms and experiences. Yet they defied professional judgements that they had not recovered to claim that they had indeed recovered lives that they valued, with friends, meaningful things to so, a reasonable place to live and enough money to buy most things of importance to them. Since it is the quality of day to day life - rather than the presence or absence of symptoms - that defines recovery for the vast majority of people with mental health conditions, one has to ask, what is the role of mental health services?

Certainly, at times of crisis, of most distress, even desperation, then professional support can be invaluable. It can be helpful to have all responsibilities removed, to be given "asylum", time and space to recuperate; it can be comforting and reassuring for someone to draw on their professional expertise to tell you what has helped others, what they believe might help you and what they would do if they were in your position. Of equal importance are people who have found ways of coping, who have found a way through to a decent life, who are not frightened by severe distress, who are kind, compassionate, solution-focused, who acknowledge your feelings and offer information, guidance and a belief in your possibilities of recovery.

However, we spend relatively little of our lives in acute crisis, and we would spend considerably less if those in our communities were more confident in their abilities to both accommodate and support us. Mental health services will always be changeable: personnel will change (because of promotion, leave, moving from one organisation to another) and teams will be reorganised. Since the vast majority of anyone’s life is lived in their communities - the groups of people who share their culture, interest, gender, family, belief and geography, etc. It is in these places that we are most likely to find the ongoing support and companionship that both triggers our recovery and sustains it. It is within our circles of friends, family and colleagues that we are most likely to find people who really care for and about us, who believe in us - not because we are "their patient" but because they know us and appreciate the contributions that we can make. It is in these circles that we build our self-esteem, self-confidence and self-belief. It is in these places that we really do begin to recover.

This is not to discount the role of mental health services - but to inform it. Rather than seeking to "fix" the people who use their service, they should rightfully see their role as enabling us to manage our condition, supporting us to find ways of living the life we want to lead. Rather than seeing themselves as the primary and central source of mental health support and care and "the community" as the next step in a recovery journey, services need to recognise their position as just one of a range of facilities, services and supports which all play a role in keeping people well in any community. Services can provide effective support at times of severe distress and disturbance, they can both minimise symptoms and help to preserve valued roles and relationships. But rather than prescribing the best treatment, offering professional expertise to a passive patient, they can best achieve this by actively collaborating with the person, their family and friends to agree together how their distress might best be alleviated, how they can best be enabled to achieve their own goals, how they can best access the support, information and adjustments that they need to participate fully, how they can best achieve a speedy return to a supportive and supported community.

As public service budgets become ever tighter, it will be essential for mental health services to recognise their rightful role in supporting recovery. Their resources will need to focus on what they do best: focusing on alleviating severe distress and disturbance; maintaining valued roles and relationships and supporting family and friends; enabling the person to access the assistance they require to achieve their goals and play a full participating role in society. This shift and focus is not merely an economic necessity, it would enable services to prioritise and provide more effective targeted support whilst supporting communities to become much better at what they already do.

Communities hold a wealth of untapped resources, mainstream organisations and facilities: places of worship, arts, sports and culture; neighbours, family members, colleagues. Services need to become much better at helping people to access these facilities, and to participate fully through carefully tailored adjustments and support to both the individual and family/community. Few mental health services have developed integrated services with well used pathways through to valued roles and relationships in communities, yet there are increasing, policies, structures and mechanisms to aid this process.

Self-directed support through direct payments and personal budgets is available for people with disabilities (including mental health problems) to purchase the type and level of support that they require to achieve their personal goals. As yet, there is relatively low uptake of self-directed support among people with mental health problems. However, this can make a huge difference to people’s lives, enabling them to do the things they want to do, with support that suits them. This reduces their reliance on mental health services: rather than waiting for a visit from a community mental health team member, they could have a personal assistant to take them out for a walk, to see a film or to a self-help group.

Social prescribing is another little used approach that has been shown to reduce the call on statutory services for social support (Friedli et al., 2008). This is about linking people up to activities in the community (non-medical sources of support) that they might benefit from. Thus, GPs might refer a person to a local voluntary group who will support them to access groups and activities that fit in with their interests and abilities, that enable them to meet people who have similar experiences. This is an effective way of alleviating isolation, loneliness and boredom, and pilot studies have shown significant reductions in use of primary care services as a result.

Recovery Colleges are now provided in almost two-thirds of the areas covered by NHS Mental Health Services. These work in collaboration with local communities to provide co-produced education to enable people to take back control of their condition - and more importantly of their lives. They run like further education colleges in that students enrol on the courses that they believe will be most helpful in enabling them to achieve their goals. Courses do not only cover mental health problems but life skills as well: managing your tenancy, understanding your benefits, getting back into work and education, eating well, looking after your physical health, etc.

Third sector partners offer all kinds of mutual support, self-help, specialist advice and services. They are more successful and effective when working in partnership with statutory services so that they can offer complementary support rather than duplicating provision, and so that referrers are well informed about what they offer, how to access them, etc. We are seeing increasing use of formal partnership models. For example alliance commissioning groups where several different types of services in a local area work together to provide a comprehensive range of interlocking services, often integrating primary and secondary support, health and social care for mental health problems with support to access education, employment and direct payments for social care.

Papers in this journal are increasingly describing initiatives which cross boundaries, creating a bridge between statutory services and local communities (e.g. Creative Minds in south west Yorkshire), between staff providing professional support and peers providing mutual support (e.g. Prosper in south west London); between statutory services and self-directed care (Real Lives in Nottingham); between being a service user and becoming a volunteer working in the service (Oxleas in south east London). We envisage a greater proliferation of such initatives on a more or less formal basis, both filling the gaps that services cannot fill, and more importantly finding more effective and successful ways of enabling people to live the life they want to live alongside the people they choose to be with.

Reference

Friedli, L., Jackson, C., Abernethy, H. and Stansfield, J. (2008), "Social prescribing for mental health - a guide to commissioning and delivery", CSIP Services Improvement Partnership, North West Development Centre, Manchester.