CAB - Citizens Advice Bureau – Salford Mental Health Services – 25 year report

Salford Mental Health Services

Citizens Advice Bureau Providing quality services for 25 years: 1986 – 2011

Charity registration no: 1102333

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“ The Citizens Advice service provides free, independent, confidential and impartial advice to everyone on their rights and responsibilities. We value diversity, promote equality and challenge discrimination.”

The service aims: • To provide the advice people need for the problems they face •T o improve the policies and practices that affect people’s lives

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Contents Providing quality services for 25 years: 1986 – 2011

1: Chair’s review

2: Equal opportunities

3: Why we are here

4: How we work

5: Effecting change

6: Highlights of the last 25 years

7: Development work

8: The way forward

9: What our clients think

10: The staff team

11: Our funders

12: Get involved

Back page: Contact us The Citizens Advice service is independent and offers free, confidential, impartial advice to everybody regardless of gender, race, disability, religion and belief, sexual orientation or age.

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1:Chair’s review Whilst many people have heard of or used Citizens Advice Bureaux, not many people perhaps know that each bureau is a charity in its own right and the work of the bureau is overseen by interested individuals who act as charity trustees.

Many people are unaware that not only do Citizens Advice Bureaux provide advice to the general public through high street ‘outlets’ but increasingly they are providing advice, information and advocacy in prisons, hospitals, GP surgeries, and mental health settings. Salford Mental Health Services Citizens Advice Bureau has been undertaking this innovative work for 25 years, at the Prestwich Hospital site and mental health centres across Salford and, more recently, developing into a region-wide service.

Being an individual charity presents its own pressures and difficulties. The voluntary and charity sector is stringently regulated. The quality of our work is overseen by our national organisation, Citizens Advice, and the Legal Services Commission. We hold the Community Legal Services Quality Mark in Health and Community Care,

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Welfare Benefits, Debt, Disability, Women and Mental Health. The Charity Commission oversees our work and spending. We do not receive core funding from central or local government. Our core funding comes from Salford PCT for advice and advocacy work with users of mental health services across Salford and various funders support our other advocacy services. Each funder has different expectations and requirements. Just maintaining existing funding is difficult enough. For example, the essential work we carried out at the community mental health centres, which had to come to an end because we were unable to find replacement funding following the end of our second lottery grant, was reinstated following a successful application by Citizens Advice to the Financial Inclusion Fund, a government initiative paid via the Department for Business, Innovation and Skills. That funding too was due to end in March 2011 but after sustained negotiations

the government agreed in February 2011 that funding would be continued for one year only. Thus, the pressures on the voluntary sector can be immense. Our staff work under conditions of great uncertainty and the current economic climate intensifies this.

The changes and reforms ahead will place great demands on the services we provide. Of course, voluntary and charitable organisations need to be accountable but this burden can appear quite immense at times.

Nevertheless, we mustn’t forget those whom we are here to serve.

The bureau deals with some of the most vulnerable and disempowered people in society and our work with them is very rewarding.

Assisting someone with mental health needs through the complex welfare benefits maze, helping them to challenge the Benefits Agency and ensure that they get the benefit entitlement they deserve can be very rewarding. It is amazing to see a person’s relief when they hear that we can

help them with their debts (no matter how large) and help them negotiate with their creditors.

Some rewards are not as quantifiable but equally as important, such as supporting a disempowered patient to put forward their views and seeing them grow as a person to be able to speak up for himself or herself.

People don’t always want financial compensation; through our work in supporting people to make complaints about the services they have received, the bureau has also invaluably helped patients to hear the word ‘sorry’ from a daunting NHS organisation.

Finally, some acknowledgements.

I would like to thank the rest of the Board for their support to the bureau. I would like to thank Annette Gaskell and the staff team for their hard work. Thank you to the organisations that fund the work of the bureau.

Finally thanks to our parent organisation, Citizens Advice, for their support behind the scenes.

Brian Burke Chair

During the last year we have been delighted to welcome two new members to our Board of Directors and Charity Trustees.

It has traditionally been difficult to recruit to this challenging and demanding role and it is in no small way due to the continued commitment, support and work of our members over the years that the bureau has gone from strength to strength.

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2:Equal opportunities People with mental health needs face discrimination on a day-to-day basis. We are committed to empowerment through positive action, which underpins all aspects of the work we carry out.

We are committed to providing accessible services, to look at areas of unmet need and consider how we might meet those needs. We aim to continue to improve our performance through the development of good practice.

As an organisation, we aim to reflect the diversity of the community we serve and play an essential part in tackling injustice, reducing poverty and social exclusion and enabling people to realise their full potential.

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We encourage users of mental health services to be involved in the running of the bureau, to serve as members of the Board of Trustees and as staff, both paid and voluntary. We aim to identify barriers to user involvement and look at how we can overcome them.

Everyone who is involved with the bureau should have a sound commitment to equal opportunities within the provision of bureau services.

The Citizens Advice Bureau service helps people resolve their problems by providing free, independent and confidential advice, and by influencing policymakers. We value diversity, promote equality and challenge discrimination.

3: Why we are here Salford Mental Health Services Citizens Advice Bureau offers independent, free, confidential and impartial mental health advice and advocacy.

The Citizens Advice service aims to • provide the advice people need for the problems they face • improve the policies and practices that affect people’s lives In practice, this means ensuring that individuals do not suffer through lack of knowledge of their rights and responsibilities, or of the services available to them, or through an inability to express their needs effectively and equally, to exercise a responsible influence on the development of social policies and services both locally and nationally.

All Citizens Advice Bureaux are committed to the aims and principles. The way in which they apply them to their own work may vary.

The first aim is the one which most people would recognise as a description of the role of a Citizens Advice Bureau. Its purpose is to enable people to manage their own problems.

This is particularly relevant to the work at this bureau and often means that we work in an advocacy role with people generally recognised as disempowered and potentially vulnerable.

We offer intensive, long term support to enable people to deal with the issues affecting them.

Resolution of such issues does aid recovery, demonstrating the health benefits of targeting advice and advocacy services towards meeting the specific needs of people with mental health problems. The fundamental need for independent, specialist services within mental health settings is widely accepted and is particularly relevant where inpatients are unable to access community based services.

Health problems are influenced and compounded by social deprivation, which stems from unemployment, poor housing conditions and poverty. Poor health is closely intertwined with other aspects of deprivation, but it is also an important aspect of deprivation in its own right.

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3: Why we are here Chronic ill health and disability greatly impair the quality of people’s lives. Lack of uptake of benefits is a major factor in deprivation and poverty levels among our clients. The pressures of poverty are a major factor contributing to mental health crises and social exclusion.

The second aim relates to activity of a social policy nature. This works to prevent similar problems arising for other people. Through social policy, we also work to raise awareness of mental health issues. By providing training and consultancy to other agencies and user groups, we work towards enabling them to improve their services to the client group, increasing accessibility in the wider community.

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Working within the aims and principles, we aim to enable and empower users of mental health services: • By ensuring they receive accessible specialist help and support at the right time, regardless of mental distress • By promoting awareness of the needs of service users to aid social inclusion • Through the provision of advice, advocacy and training services

4: How we work Our main office is based at the Prestwich Site of the Greater Manchester West Mental Health NHS Foundation Trust.

Our services are delivered via a range of routes, including mental health in-patient units, community mental health centres, by telephone, 24 hour messaging, home visits, outreach sessions, appointments and drop-in sessions.

Advice

Case Study

The bureau provides complex benefits advice, including sickness and disability benefits which can be difficult for people with a mental health diagnosis to claim successfully, from making an initial claim to representing clients appealing to the first tier tribunal and beyond by making applications to the upper tier if decisions involve an error of law. The bureau also provides debt advice to many of these clients, which involves negotiation with creditors through to representation at court hearings and we assist with housing issues, including e.g. appropriate accommodation.

We attended a tribunal with a client claiming incapacity benefit, which was terminated due to the client scoring only 2 points at the medical. The client had a longstanding diagnosis of bi-polar disorder. He found it hard to talk about his illness and the effect it had on his life. The bureau helped the client to build a case demonstrating that due to the effects of his mental ill health, his score should have been a lot higher and that the low result from the medical was due to a number of factors, i.e. he was not given enough time to answer questions and he was not in good health at the time of the medical. Although he had tried to make the staff aware of this at the time, it was not taken into account. We supported the client in presenting his case to the panel. The hearing was successful and the client’s benefit was reinstated after seven months of waiting. The client received a payment backdated for seven months.

Clients are encouraged to make their own decisions and act on their own behalf. We enable clients to manage their own problems by focusing on their needs as individuals.

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4: How we work Advocacy Many of our clients feel they have had little value placed on their views and opinions over the years. We provide independent advocacy support to empower and enable them to have their voices heard and be listened to.

We offer assistance and support at hospital managers’ hearings, ward rounds, Care Programme meetings, Mental Health Review Tribunals and throughout the NHS complaints process. We also provide the statutory function of Independent Mental Health Advocate, a requirement of the Mental Health Act introduced in April 2009 for certain detained patients.

Much of our caseload relates to issues around care and treatment, discharge and aftercare, patients’ rights and issues arising under the Mental Health Act. Brief examples include work with clients receiving section 117 aftercare provided by health and social services, issues around clients’ level of involvement in their own care and treatment planning and

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detentions occurring outside the provisions of the Mental Health Act, all of which potentially give rise to human rights issues.

Case Studies We supported a client and her family who requested discharge.

As a community care co-ordinator had not been allocated we contacted the community services to advocate the necessity for a care co-ordinator to be allocated quickly. During meetings, the client felt confused and received mixed messages about the likely length of admission. We met with the consultant and case manager and requested that transparent information is given about this as the client and her family were losing confidence in the service.

The client has quickly progressed to day services although it was a longer process than was initially expected.

Another client was supported in meeting with his primary nurse regarding his care plan. This was in relation to the development

4: How we work of coping strategies which he needed to use when he was feeling unwell. A previous coping mechanism had been to use time out and he felt that after moving wards the new staff did not facilitate his continuing to utilise this. As a result of not being able to take time out, he became unable to manage his feelings and he became involved in a confrontation on the ward.

As a result, his leave was stopped until the weekend which he felt would cause him particular difficulty because he had wanted to access services which were not available at weekends. The advocate explained the patient’s concerns to his primary nurse, who agreed to look at the care plan later on that day with a view to making amendments which would enable the patient to have adequate coping strategies to manage his feelings.

Influencing change We work to influence change, by monitoring issues which affect our clients and campaigning for change, to resolve problems on a wider scale and prevent the same difficulties arising for others. We reject the idea that people with mental health issues must be fully recovered before they can be fully included and we work to make disability equality as valid for people experiencing mental illness as it is for other disabled people. In this, we work toward raising awareness of mental health issues, attending local and national forums, providing training and consultancy to other agencies and user groups, sharing good practice, enabling them to look at their services objectively and to develop and improve their services. In this way the bureau undertakes a valuable role in encouraging inclusive practice.

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4: How we work Case Study We support clients in preparing for CPA review meetings by compiling client reports, discussing issues clients wish to raise and discussing reports prepared by the multidisciplinary team. Over the years we have worked to ensure that clients are included in care planning and that their voices are heard.

One CPA meeting concluded that the client would transfer between wards; this is not the usual pathway and we were informed that this was due to the client’s mental state deteriorating. The client was transferred very suddenly and he questioned this decision as he felt he did not receive any explanation or opportunity to contribute prior to transfer. We supported him to represent his views at the CPA meeting and it was agreed that an explanation should be provided; however, this did not happen until after the transfer had taken place.

We are liaising with the consultant to try to gather more information and assist the client in understanding why the MDT made this decision.

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5: Effecting change The CAB service aims to improve the policies and practices that affect people’s lives, by providing a responsible influence on the development of practice and policies locally and nationally • We work with our national organisation to provide evidence of the effect of social policies, which is used to influence policy at a national level • We use information gathered from the experiences of our clients to effect change where new legislation, policies and practices affect mental health service users • We have worked with the Office of the Deputy Prime Minister to address social exclusion

• We are in a unique position to comment on the local practices and policies of the wards, hospitals and other units where we see our clients, as well as national policy and new legislation impacting upon mental health service users, and we work to raise awareness of how they may be affected • We work to promote empowerment and the importance of gender and culturally sensitive services, and to develop exceptional services that fully engage all clients.

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5: Effecting change • We work with the North West Mental Health and Welfare Rights Group, which supports workers in the mental health field doing benefits based work • We are working to raise awareness of bullying within secure mental health services and to develop an intervention strategy

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The Citizens Advice Bureau service helps people resolve their problems by providing free, independent and confidential advice, and by influencing policymakers. We value diversity, promote equality and challenge discrimination.

• We work with community legal services to develop legal services addressing the needs of mental health service users which are not related strictly to Mental Health Act issues • We provide training to other groups and organisations to enable them to help clients deal with the issues that affect them, to address discrimination and develop good practice

6: Highlights of the last 25 years Highlights of the last 25 years: 1986 – 2011

1986

Citizens Advice Bureau opens at Prestwich Hospital.

1987

Funding is agreed for a manager and caseworker.

1988 Workload increases as Care in the Community policy sees people moving out of long stay psychiatric hospitals.

1989

Advice work begins in the community based Mental Health Centres.

1990

Advocacy work begins at the Edenfield Centre.

1991

Disability Living Allowance is introduced.

1992 Extra funding is agreed for a full time manager, a part time deputy manager, caseworker and office administrator.

1993 Bureau splits from the Prestwich CAB and is registered as a Charity in its own right. Emerging group advocacy developed for those people still left on longer term wards.

1994 1st Annual General Meeting of Salford Mental Health Services CAB is held. Lively debate takes place as to whether people with mental health needs need specialist advice services or more generic ‘high street’ services. The majority view is that specialist services are preferred.

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6: Highlights of the last 25 years 1995 The Bureau instigates a motion at the Citizens Advice annual conference which commits the whole service to equal opportunities for people with mental health needs. The motion is passed. A pilot research project looks at the advocacy needs of people in acute mental health settings.

1996 Lottery funding is awarded to further develop outreach services at Community Mental Health Centres.

1997 Funding is agreed and advocacy service in acute setting is established.

The Bureau instigates a motion at the Citizens Advice annual conference opposing proposals to remove Hospital Managers’ hearings.

1998

Self Advocacy Skills Review model established.

1999

Funding is agreed for advocacy services in secure settings.

2000

Millennium Volunteer project takes off.

2001

HRH The Princess Royal, Patron of Citizens Advice visits the Bureau.

2002

Pilot ICAS service launched by the Mayor of Salford.

2003 Bureau is awarded Community Legal Services Quality Mark in Welfare Benefits and Debt.

2004 The Office of the Deputy Prime Minister visits the Bureau and our work is recognised in the Report on Mental Health and Social Exclusion.

2005 Bureau is awarded Community Legal Services Quality Mark at Specialist level in Mental Health.

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2006 Awarded Legal Services Commission contract in Mental Health, one of only two voluntary sector contracts in the north west of England. Financial Inclusion Fund project begins.

2007 Bureau celebrates 21 years of successful service delivery. Awarded Community Legal Services Quality Mark in Disability, Women’s issues, Health and Community Care. Development work begins in low secure and young people’s mental health services to establish advocacy need.

2008 Bureau wins a major advocacy contract via open competitive tender, one of the first bureaux to take part in the commissioning process.

2009 Funding is agreed to continue advocacy provision for young people.

2010 Citizens Advice celebrates 70 years of service delivery.

Bureau wins Citizens Advice award for Best Equality and Diversity Campaign.

2011 Bureau celebrates 25 years of successful and innovative service delivery.

Independent Free Confidential Impartial

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: Development work Over the years, the bureau has worked with many individuals and organisations.

We are committed to user involvement and we consult as to service requirements. The lessons learned from this have been used to develop good, inclusive practice and enhance delivery of our own services and those provided by other organisations.

In doing so, we have developed the following documents:

Policy Documents • Code of Practice for Advocates • Self Advocacy Skills Review • Pro forma for preparation for ECC meetings • Policy for Prioritising Advocacy Services • Policy for working with people in seclusion • Policy for Managing Reactive Advocacy • Policy on Uninstructed Advocacy • Policy for working with Vulnerable Adults • Policy for the Employment of Ex-offenders

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The Citizens Advice service is independent and offers free, confidential, impartial advice to everybody regardless of gender, race, disability, religion and belief, sexual orientation or age.

Training Materials • Mental Health Awareness • Mental Health and Benefits • Mental Health and Debt • The Mental Health Act 1983/2007 • Rights under the Mental Health Act 1983/2007 • Developing Self Advocacy Skills • Representing Service Users • Working with people who lack Capacity • Developing User Involvement • Bullying – Awareness and Prevention All of our training materials include elements which address discrimination and promote action towards equal opportunity.

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8: The way forward During the coming year our objectives will be: • To continue to work to promote social inclusion and reduce inequality • To make our services more accessible • To represent our clients’ interests • To continue to provide quality services • To secure the resources we need to achieve these goals

In working towards these goals we will: • Extend our local, regional and national services • Develop our training and consultancy provision and share good practice • Develop new partnerships to provide innovative services that meet the needs of our clients • Build long term relationships with key stakeholders • Ensure that equality and diversity forms part of all our activity

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Independent Free Confidential Impartial

:What our clients think “ The CAB has worked very hard for me and achieved good results. I could have done nothing without your help.

My outlook on life has improved and I’m now taking more interest in things.” “ You’ve been a really great help.

I didn’t know what to do. It’s hard for me to talk about things but you understand. I feel a lot better after getting help from the CAB.” “ I just wanted to say thank you for everything that you have done for me. You have made my life a lot easier.” “ Thank you for your support.

You stepped in when I was about to give up.” “ You understood what I was trying to say and helped me get my problem resolved.”

“ Your organisation is the only one that’s treated me with any respect or dignity. Thank you for your help.” “ This is in gratitude for all your hard work, help and support.

We couldn’t have wished for anyone better and we feel we have also gained an understanding friend.

Thank you.” “ I am so pleased and relieved that you understood me, my issues were very complex and you made everything clear, and you made… see how important it was. Thank you.” “ I cannot thank you enough for what you have done for me.” “ I am delighted and want to say a sincere thank you for your help.”

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: What our clients think “ Thank you for your support and for being there. I have been going through a difficult time and it has been easier with your help.” “ You have treated me with a professionalism, empathy and determination I have received from no-one else during my battle with mental illness.’’ “ Without your determination, tenacity and support, I’m not sure I would have got through this past six months.’’

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“ I can say without reservation you have made a huge difference to my life and lifted burden after burden from my shoulders.’’ “ Patients are much more open.

We really appreciate your input.’’

Consultant, GMW

“ A real step forward in empowering people, as citizens as well as patients, not only to get the best results for their own personal circumstances but for our health service too.”

Ian Stewart, M.P.

Board of Directors and Charity Trustees Brian Burke Chair Andrew Atkinson Vice Chair Ethar Alali Harold Kershner Jeremy Bernhaut Nick Money

The Board of Directors and staff of Salford Mental Health Services Citizens Advice Bureau would like to thank everyone who has been involved with and supported the bureau over the last 25 years – volunteers, staff, trustees and Board members, commissioners, funders, Citizens Advice and most of all, the clients who have used our services.

10: The staff team 1: Annette Gaskell

Strategic Manager

2: Rabana Khan

Operational Manager (Advice)

3: Amber Wardleworth Operational Manager (Advocacy)

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4: Helena Gaskell

Administrator

5: Robin Jamil

Mental Health Advocate

6: Liz Bradford

Mental Health Advocate

7: Charlotte Gaskell

Mental Health Advocate

8: Julie Cohen

Mental Health Caseworker

9: Kung Lee

Mental Health Caseworker

10: Adam Reed

Volunteer Adviser

11: Chris Cullen

Volunteer Adviser

12: Aisha Kabejja

Volunteer Adviser

13: Katie Wong

Volunteer Adviser

14: Mohammed Behat

M.A. Student (Social Work)

We would like to dedicate this Review to the memory of Brian Dunphy, who passed away in January 2010. Brian had become a good friend as well as an exceptional volunteer. He touched many lives and he will always be missed.

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11:Our funders Salford Mental Health Services Citizens Advice Bureau is a registered charity and relies on the support of a range of funders.

A diverse funding base is vital to maintain accessible quality services.

We would like to thank commissioners of our service, past and present, for their support over the years: • Salford PCT • Salford City Council • North West Specialised Commissioning Team • Lloyds TSB Foundation • Citizens Advice • Greater Manchester West Mental Health NHS Foundation Trust • Secure and Forensic Mental Health Commissioner, Greater Manchester Mental Health Network

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Independent Free Confidential Impartial

• The Legal Services Commission • The Department of Health • The Department for Business, Innovation and Skills • National Lottery Charities Board

12:Get involved We are always looking for more people to get involved and support the invaluable work of the bureau.

Being a charity trustee isn’t the easiest of jobs but it can be very rewarding. If you are interested in contributing to our work and particularly if you have experience of using mental health services, financial or business experience or if you represent a relevant organisation, we would like to hear from you.

Working as an advocate, you will be supporting some of the most vulnerable and disempowered people in society to be listened to.

Volunteering as an adviser means you will be helping people resolve their legal, money and consumer problems. We provide free, formal, on the job training which meets CitA national standards.

• Advocacy

We would like to hear from you if you are interested in volunteering.

We need volunteers to help us provide the following services: • Advice • Board of Trustees

The Citizens Advice service is independent and offers free, confidential, impartial advice to everybody regardless of gender, race, disability, religion and belief, sexual orientation or age.

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Notes

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Contact us Telephone 0161 772 3506 24 hour answer service.

Leave a message and telephone number.

We will contact you.

You can also text us on this number.

Fax Email Write

0161 772 3508 main.bureau@smhscab.org.uk Salford Mental Health Services Citizens Advice Bureau Prestwich Site Bury New Road Prestwich Manchester M25 3BL

Salford Mental Health Services Citizens Advice Bureau is committed to equal opportunity.

This Report is available in large print, on tape or CD ROM. A summary is available in other languages on request.

This Report was designed by SMaRT Design & Print. SMaRT (Socially-Minded & Responsible Trading™) is a social enterprise run by First Step Trust (FST), a charity that provides real work, training and employment opportunities for people excluded from ordinary working life because of mental health issues or other disadvantages.

Telephone 0161 772 3961 Email fstsalford@firststeptrust.org.uk All photography by © Neil O’Connor, except back page image.

Back page image © Citizens Advice

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