London Well-being Conference: Better Mental Health King’s Fund, London 2 February 2010
Contents
The Event
2
Opening Plenary Policy and Strategy
3-5
Stephen Howlett Chief Executive | Peabody Peter Wanless Chief Executive | Big Lottery Fund Paddy Cooney Programme Lead | Social Inclusion & Social Justice (PSA16) | NMHDU Paul Farmer Chief Executive | Mind
Second Plenary Best Practice
6-7
Paul Finch OBE Chair | CABE Simon Lawton-Smith Head of Policy | Mental Health Foundation Charles Fraser CBE Chief Executive | St Mungo’s Judy Weleminsky Chief Executive | Mental Health Providers Forum
Workshops Creating Happy Places Community Led Initiatives Partnership Working and Signposting
8 9 10
Final Plenary The Conference Debate
11-12
Summary
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The Event The first London Well-being Conference: Better Mental Health was held at the King’s Fund on 2 February 2010. Over 120 delegates attended the event, from the housing, mental health, private, public and third sectors. Peabody sponsored the conference as part of the Big Lottery-funded Activate London initiative, which promotes physical exercise, good mental health and healthy eating through a range of community projects. Activate London is led by Peabody in partnership with Broomleigh Housing, CBHA, Circle Anglia, Family Mosaic, Metropolitan Housing and Southern Housing. It is well recognised that where people live – their home, as well as the surrounding community – has a significant impact on their mental health and sense of well-being. Housing associations like Peabody manage some 410,000 properties in London and provide a home to around one in every 10 people. They are therefore uniquely placed to deliver a range of services within communities to promote well-being and mental health. However, it is clear that local successes achieved by innovative programmes such as Activate London are in danger of being outstripped by inequality and rising economic hardship. There is an urgent need to develop more effective cross-sector partnerships to tackle the roots of poor mental health in our communities. The inaugural London Well-being Conference arose out of this need.
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Opening Plenary | Policy and Strategy Martyn Lewis CBE welcomed delegates to the first London Well-being Conference, and outlined the purpose of the first session: to set out the latest policy and practice aimed at supporting those with mental health issues within a social housing context; to unpick definitions of mental health; and to look at how mental health and well-being affect individuals and communities.
Stephen Howlett | Chief Executive | Peabody “A good home and community is a basic building block for a good life” Stephen began by highlighting a recent survey by the OECD which ranked Britain as one of the most unequal countries in the developed world. Poverty brings with it a raft of health problems, including poor mental health, and it was imperative these were tackled now. The conference was an urgent call for action to work in a more joined up way to deal with the challenges facing communities. He went on to outline the work Peabody already undertakes to promote well-being through the flagship Activate London programme and a new project, Re-Connect, for unemployed and socially excluded adults in deprived areas of London. Concluding, he called on delegates to look to build on these initiatives and develop crosssector partnerships to foster thriving, sustainable communities into the future.
Peter Wanless | Chief Executive | Big Lottery Fund Peter outlined the work of the Big Lottery Fund (BIG), the largest distributor of lottery funding in the England, and its well-being programme. The programme was massively oversubscribed with applications amounting to over £1.2 billion for £160 million of available funding. Activate London was an excellent regional example of an initiative funded via the well-being programme. “It is essential to involve the local community in the running and development of programmes” The importance of promoting mental well-being through BIG funding had been backed up by a variety of evidence. He stressed that mental health should not be seen as an isolated issue as it affects all areas of people’s lives. Indeed, the focus should be on well-being not simply mental illness. The Young Foundation report, Sinking and swimming, which found that anxiety and depression are set to double over the next decade, indicated that these issues should become the focus of policies and programmes.
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The value of good evaluation was highlighted, with particular reference to the well-being programme evaluation undertaken by the Centre for Local Economic Studies and the New Economics Foundation. Peter was keen to see that these findings were actively fed through to future projects.
Paddy Cooney | Programme Lead | Social Inclusion & Social Justice (PSA16) | NMHDU Paddy began by referring to the “paradigm shift” coined to describe the shift in the treatment of mental illness from large, isolated institutions to integrated community services. This shift had the benefit of enabling those with mental illnesses to more easily rejoin the “life line” of their communities. He also referred to the Department of Health’s recent New Horizons report, which sets out a ten-year programme of action for improving mental well-being and care services for people with poor mental health by 2020. Until recently, he noted, housing was often left out of plans for improving mental well-being (he tendered an apology on behalf of the mental health sector for this oversight). The two sectors thus ended up on parallel paths. This had to change. “If we don’t open the door, you’ve got to kick it in.” He argued that housing associations could achieve more in communities – more effectively, more cheaply – than current service deliverers because they are able to put mental health services “where people’s lives are”. The further services were moved from where people live, the greater the cost. He went on to highlight the importance of employment to well-being. Work provides status, purpose, social relations. “Take work away and what remains?” Work cannot be considered a discrete part of our lives. Only 24% of people with mental health problems are in work, yet they have the highest “want to work” rate of any group. He added, 50% of people who came into contact with mental health services will have lost their job within one year.
Paul Farmer | Chief Executive | Mind “90% of those with mental health issues experience stigma in their daily lives” The session ended with a rousing presentation by Paul Farmer. He began by stating that we are at a time of change, when the value of working in partnership and across sectors is clearly evident. This was “a chance in a generation”. The conference was timely and important: an opportunity to ensure dialogue takes place between sectors; a first step towards embedding housing in the mental health and well-being agenda. 4
Much of the debate around mental health often focuses on treatment, but it should in fact be considered in terms of people’s lives. The mental health “journey” is not simply about seeing a doctor. With one in four people with a mental health problem, a key issue was the need to break down associated stigma. Mind is a lead partner in Time to Change, an ambitious campaign to end discrimination faced by people who experience mental health problems, as well as improve the nation’s well-being. Mental health must be discussed openly. Paul reiterated Paddy Cooney’s point that housing has not been high enough on the mental health agenda. Both sectors could learn from each other; fostering and incentivising partnership working was an outcome that both should strive for. We need a more “virtuous circle” in our approach to mental health and well-being, joining better services, systematic partnership working, improved outcomes and efforts to tackle stigma and discrimination. He concluded with the emphatic statement, “Mental health is everyone’s business”
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Second Plenary | Best Practice The second session heard firsthand from those at the forefront of promoting mental health at a variety of levels. Case studies detailed how the built environment, community-based and technological solutions have been able to address mental health issues.
Paul Finch OBE | Chair | CABE Paul began the second session by looking at the role built environments play in sustaining well-being and mental health. He noted that there had been a move towards focussing on complete environments, not simply on homes. “Social housing can blaze a route towards healthier environments” The value of built environments to well-being could be increased, he stated, without raising overall costs to developers. There are examples of built environments that are conducive to developing and encouraging mental health. Social housing could “blaze a route” to healthier environments. Public spaces make no distinction between people’s means or socio-economic background; they raise everyone to the same level. Access to green space is often a measure of deprivation.
Simon Lawton-Smith | Head of Policy | Mental Health Foundation “The one policy I would drive would be to tackle stigma particularly in teenagers” Simon began by explaining how the New Horizons strategy built upon the 1999-2009 National Service Framework for mental health, which, importantly, focussed on the wellbeing of the whole population, not just those with mental health problems. However, he contended that there is still a need to improve early intervention techniques for young people and families. Simon was conscious that examples of best practice need to be integrated with future policy and not just seen as “islands of success in a sea of failure”. Many of the issues being grappled with today were well-known 15 years ago, he noted. If the aims of the New Horizons report were to be achieved, entrenched barriers must be overcome.
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Charles Fraser CBE | Chief Executive | St Mungo’s “We have to believe that nothing is intractable” St Mungo’s is London’s largest charity for homeless people, providing homes and a wide range of support services. In many cases, Charles said, “It is the [mental health and wellbeing] services that are hard to reach, not the people.” There a great deal of mental health issues in the homeless community; homeless individuals often have three of four mental health needs. Safe, supportive housing was essential to support the work St Mungo’s does to promote good mental health and wellbeing. Charles outlined two examples of St Mungo’s good practice: the Brent Dual Diagnosis project, which provides housing and support for adults with a combination of mental health and substance use needs; and the Lifeworks project, which offers homeless adults comprehensive access to psychological therapies.
Judy Weleminsky | Chief Executive | Mental Health Providers Forum The Mental Health Providers Forum works to promote the role of voluntary sector mental health organisations in the delivery of recovery-focussed mental health services Judy began by seeking a definition of “well-being”. “What do we mean by well-being?” Importantly, the plethora of different definitions show that “well-being” is multifaceted, encompassing happiness, sense of purpose, fulfilment, physical health and more. Any agreed definition must embrace this multiplicity of meanings. “Those in the voluntary sector were the ones to lead the focus on well-being and still have a lot to contribute” Judy demonstrated the MHPF Recovery Star to delegates, highlighting its usefulness in measuring and assessing change in people’s lives. The Recovery Star had been used with great success; a similar model could be developed to create a “well-being star”.
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Workshop | Creating Happy Places This seminar sought to analyse how the physical design of urban environments impacts upon people’s mental well-being. It also looked at how housing associations and other institutions can create environments conducive to good mental health. The session was chaired by Mathew Frith (London Wildlife Trust), who was joined by Andy Groarke (Carmody Groarke Architects) and John Hocking (Joseph Rowntree Housing Trust). Several issues arose during the session: • Tenure has become a value judgement – the group felt that a more relevant discussion should be around the promotion of mixed income level developments. • How buildings can be managed and maintained long term. • Resident involvement is vital to ensuring the development of successful housing. Also, are residents asked the right questions when they are consulted? • OJEU guidelines often hinder design quality. • A group of “community philosophers” should be put in place to broker decision making and deal with disagreements. • There is a need to increase individualisation in developments. • However, while the needs of individuals must be considered, housing must be flexible for the future. • It is important not to underestimate the level of investment and resources required to design and manage “happy places”. However, committed investment at the outset of a development can reduce social costs further downstream.
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Workshop | Community Led Initiatives This seminar looked at how grassroots organisations can promote positive mental health using non-clinical, affordable methods. This session was highly interactive, and delegates heard from Andrea Purslow (Peabody), Di Kitson (Time to Change) and Brigid Morris (Open Up). The group spoke about the challenges which face organisations seeking to deliver projects. Five important issues emerged from the debate: • The importance of participant ownership and leadership. • How to get commissioners to see the value of projects (and in particular what evidence is needed). • Ensuring well-being is a core service of housing organisations, not just a bolt-on. • How service providers can be flexible and take risks. • Ensuring front line staff get the support they need.
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Workshop | Partnership Working and Signposting This seminar sought to establish how an interdisciplinary and multi-agency approach to community work can address the mental health requirements of residents. There was a particular focus on the use of technology to deliver services. Stephen Burns (Peabody), Fiona Dawe (YouthNet) and Sarah Hamilton-Fairley (Start Here) led the debate. The session highlighted several areas for further consideration: • The issues involved in open-door cross-sector working. • How housing providers can actively engage with delivery organisations. • The importance of easy access to services. • “Digital natives”, and how solutions can be adapted to suit this technologically-savvy group. • The meaning of citizenship within the context of the personalisation agenda for decision making.
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Final Plenary | The Conference Debate The final session considered the way forward in developing and promoting mental health, drawing on the themes that had emerged during the day. Speakers on the panel included: Mark Easton, Home Editor, BBC News Dr Jo Nurse, National Lead for Public Mental Health & Well-being, Department of Health Dr Dimitris Ballas, Senior Lecturer, University of Sheffield Patrick Vernon, Chief Executive, Afiya Trust Linda Seymour, Head of Policy, Sainsbury Centre for Mental Health.
Question | What is the impact of the use of language when discussing mental health? How does it enable and discourage people to talk about mental health? Mark Easton said that he chooses to use mental health rather than mental illness, but has been particularly enamoured by the notion of well-being. Both Mark and Patrick Vernon commended the work which had been done to help reduce the stigma attached to mental health through high profile campaigns involving celebrities. Linda Seymour believed that the language when discussing mental health had changed over the years. She remarked that all too often mental health is equated with mental illness. A recent Office for National Statistics report showed that, on average, 16-25 year-olds in particular were very unwilling to openly discuss mental health. Often, she said, it is easier to get young people engaged for another reason to be able to talk to them about issues of mental health. Jo Nurse mentioned that recent research has highlighted that 50% of mental health problems start before the age of 14 and 75% before 18, and so a drive to encourage young people to engage is vital.
Question | How can we improve well-being in a climate of diminishing resources? Jo Nurse said that the Department of Health were working on this conundrum. Escalating costs must be dealt with, while maintaining front line services. Mark Easton felt that funding was unlikely to be ring-fenced, and as such he felt the best way to retain services was for sectors to assess their ability to provide services with the likely loss of government support.
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Patrick Vernon said that there will be cuts, but the question is how deep they will be, and where they will hit. He suggested that fiscal partnership working could make savings and add value. Dimitris Ballas said that happiness cannot be measured in GDP. We are not happier in good times and sadder in bad times. In fact, recession is a great leveller and removes some of the inequalities between social groups. The group discussed the possibility of increasing co-location of small organisations to help make them cut-proof. Finally, Linda Seymour asked the audience whether they could afford not to promote wellbeing. We are data rich but information poor. Organisations should share information and best practice to safeguard and improve service delivery.
Question | Has the economic downturn discouraged volunteering? Patrick Vernon remarked that some of the most successful volunteering programmes were in the late 1980s, when there was limited fiscal support. However, it is increasingly difficult for people to volunteer due to the increasing cost of volunteering.
Question | Under a new government is there the possibility to draw together government departments to bring this issue under the direct control of one? Mark Easton felt that change was unlikely under any new government, particularly since the cross-departmental sweep of the New Horizons report. Mark then suggested that the debate had been discussing three different target groups: those whose disorder dominates their lives; the larger group who at some point suffer from stress and depression; and finally the broader issue of having happy and meaningful lives. Mark felt these were distinct elements and needed to be treated as such.
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Summary “The future is not some place we are going to, but one we are creating. The paths are not to be found but made, and the activity of making them changes both the maker and the destination” John Schaar
Several common strands emerged during the day: 1 It is important to focus on the 16-25 year-old age group. 2 Partnership working should be a priority, partly as a reaction to the current economic climate, but also to share best practice and reduce costs in supporting local communities. 3 There must be a holistic approach to promoting well-being, with a focus that extends beyond simply treating mental illness. 4 We should seek to increase the provision of support within local communities, helping to prevent individuals from becoming disengaged from their community “life lines”. 5 Local communities must be involved in the development and running of outreach projects to ensure that they remain appropriate to their needs. 6 Government policy, as evinced by the New Horizons report, has sought to establish cross-governmental support and to increase the focus on well-being across all agendas. This must be built upon. Martyn Lewis brought the conference to a close with a message to delegates from Paddy Cooney’s presentation earlier in the day: How can my intervention help that person get back to full and proper relations in that community?”
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