Open Mind Issue 166 May-June

Get on your bike Work and wellbeing

WHAT'S NEW

FEATURES

• Health and Social Care Bill

• Taking care of business

• Psychiatry, truth and reconciliation

• Wellbeing and the world of work

• Autism and mental health

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viewpoint

Taking charge of my life Having a job is important; more important is having the right job within the right environment.

Renuka Bhakta

H

aving grown up with strong working-class ethics, work is an important part of my identity. This is my story of almost 30 years of being in and out of jobs, and learning how to make a job work for me.

in a different way. I soon recognised that I had to look for the right kind of support, and also work out when to ask for it and where to look for it, in ways other than what the mental health system was offering me.

Getting ready for the job Get a job!

One of the 3 million unemployed in the 1980s, I was 19 years old. I ‘got on my bike’, went to the council house, knocked on the personnel officer’s door and asked for a job. I got a temporary job for two weeks and stayed there for eight years until I took a two-year study break to become a social worker.

In a period of eight years, I was in and out of jobs, had different roles and umpteen caseloads, all the while feeling that I was not coping but never knowing what support I needed and how to ask for it. One of my supervisors said to me: “If it’s too hot in the kitchen, get out.” (Today I would respond to him: “If it’s too hot in the kitchen, put in an extractor fan!”) Inevitably, my confidence plummeted; I lost any sense of worth and all my confidence. I got depressed, scared and isolated.

The mental health system gave me no option except an admission on the psychiatric ward. On release, the system had not sorted me out, but left me more confused and scared about living and getting a job. I knew I had to start again with my life

I had this notion that in order to be well and stay out of hospital I needed to get back to work. It was my only understanding of how to identify myself as mainstream and ‘normal’. So I attempted to stand up and brush off what had happened in the past.

I approached my CPN and asked to go on an employment training course and attended these classes regularly for a few months. I learnt computer skills and how to write CVs, completed job application forms and conducted mock interviews. Although these were useful skills, I felt there was something missing in making that step into employment. I needed to figure out why I was still scared to go back to work, understand what had happened in my previous jobs and find out how to prevent ending up in the system if I took up work again.

Finding my way I stopped looking for jobs and attended the only open access day centre available, and found out about mental health service user run groups and black only user groups.

I had this notion that in order to be well and stay out of hospital I needed to get back to work. It was my only understanding of how to identify myself as mainstream and 'normal'.

These became my new communities. Listening to people’s stories before and after their admission in wards, I got a different perspective of being labelled ‘mentally ill’ and believing that taking medication is a cure. My quest was to look at my life, see how I would be able to stay well through ups and downs, and get a quality of life by earning and developing through a job.

I contacted Lambeth Mind and asked to do some voluntary work.

Fortunately for me I was able to start by helping in the offices, doing simple admin work. Within weeks of working there I had a very different understanding of how being supported at work was a key factor for me even as a volunteer.

I took days off when I needed them and promoted duvet days without feeling guilty, set up a support group for volunteers, had regular supervision where I was freely able to talk without it being pathologised, tried out various types of alternative therapies. In fact, I set

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taking charge of my life

up my own community project by getting money from the Scarman Trust and called it ‘Alternatives in Mental Health’. Other people I met were articulating my own deeply held values. I witnessed how things could be done differently in a working environment and learnt about genuine empowerment.

Getting the 'right' job Doing voluntary work in that organisation helped rebuild my confidence, supported me in developing new skills and reviving old skills. I found out about side-effects and medication, alternative treatments, maximising benefits, writing and talking about my experiences and actively demonstrating good practice in working environments for myself and for other volunteers and service providers.

I realised that I was becoming passionate about creating an

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alternative way of wellbeing to what is available within the mental health system. Recovering from the system as well as searching for a job, I had to figure out a way that maintained my wellbeing. So I did!

I currently work at Southwark Mind, managing a project called Kindred Minds. It was not by chance this project popped up and the job became available. I worked for it. I set myself up to go and get it. It is important to me that I work in a field that promotes well-being, campaigns to improve mental health services and recognises the importance of bringing people from different cultures together. It is equally important that I work part-time with two others in the team, allowing us to have a work-health balance. We support each other and look at ways to do it creatively.

We are the ‘experts’, and that is why it works; we set the agenda.

Sitting on this side of the fence I am able to fight back against injustices. It is a way of life I developed – it is my alternative!

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on the agenda

All change at NHS: the Health and Social Care Bill The proposed changes to the NHS must ensure improving the efficacy and availability of mental health services.

Colin Walker

T

o say that the government’s attempts to reform the National Health Service have generated some controversy would be an understatement. At their spring conference, Liberal Democrat delegates voted through a series of declarations rejecting some of the key aspects of the Coalition’s proposed reforms. The British Medical Association recently held an ‘extraordinary meeting’, their first since 1992, at which they agreed to formally resist the Government’s plans.

This has prompted the Government to ‘pause’ the progress of the Bill through Parliament and carry out a ‘listening exercise’ to address people’s concerns, particularly the fears being expressed that these reforms represent privatisation by stealth. All of this presents Andrew Lansley, the Secretary of State for Health, with a challenge. He is very closely associated with these reforms, and the concerns that they have generated in Number 10 have left him increasingly isolated. The challenge for him is to keep the momentum behind the reforms

going while simultaneously addressing the opposition that the proposals have generated.

The proposed changes These reforms have been described as the most radical since the NHS was founded in 1947. In a nutshell the proposals aim to create a health service that is: • built around the needs of the patient and involves them in decisions about their healthcare, • focuses on delivering improved health outcomes, • gives healthcare professionals greater autonomy, • makes them more accountable to the populations they serve, and • cuts down on bureaucracy and improves efficiency.

The government plans to realise this vision by moving responsibility for the commissioning of primary care services away from Primary Care Trusts and to groups of GPs, called GP consortia. In effect, GPs will become responsible for £80 billion of NHS expenditure. Furthermore, there will be significantly

fewer restrictions on who can bid to provide these services. Since this will enable private organisations to bid for contracts to provide NHS services, opponents of the reforms claim that they are the first steps towards the privatisation of the NHS.

The Health and Social Care Bill The Health and Social Care Bill, will continue to make its way through Parliament once the listening exercise is complete. Inevitably, the measures in the Bill will have an impact on mental health services, and this is why Mind is getting involved. Our priority is to ensure that whatever the government’s plans, they do not adversely affect service provision to those with mental health problems. We are keen to ensure that these reforms are used to improve their quality and availability.

Commissioning mental health services GPs are going to be responsible for commissioning mental health

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health and social care bill

services, but do they have the expertise or confidence to do this properly? Evidence suggests not. A poll by Rethink found that only 31 per cent of GPs felt equipped to commission mental health services, compared with 75 per cent for services to treat diabetes and asthma. The danger here is that, without sufficient training, expertise and support, many GPs will not make the right decisions. This is exacerbated by the squeeze on NHS finances. Mind is working to ensure that the Bill is amended to oblige GP consortia to obtain all the necessary expertise to make the right decisions about commissioning mental health services.

Public involvement Mind welcomes the Government’s intention to strengthen public involvement in the design of local health and social care services.

This is to be achieved through the establishment of local HealthWatch, whose duty it will be to obtain the views of the public and ensure that they inform the decision-making process about the services being offered in their area. The concern is that those with the loudest voices will have the greatest influence.

Since mental health service users are often among the most disadvantaged and marginalised groups in society, there is a danger that their concerns and opinions will be

drowned out, which will have a negative impact on the quality of the services that they need. Mind is working to ensure that the Bill places a duty on all relevant bodies to actively seek out the views of all patient groups, including those who are less able to engage with civic life.

Care pathways People with mental health problems often rely on a range of services. It is vital that a service user’s journey along such complex care pathways is smooth and coherent. We know that those who have to undergo repeated assessment and see an array of different professionals can take longer to recover than those whose journey is well managed.

The Bill opens up the healthcare market to any qualified provider.

Whilst this makes sense in theory, in practice increased number of service providers could make an individual’s care pathway more complicated and consequently less effective. Mind will be working to ensure that the Bill encourages, rather than prohibits, better integration in health and social care and across other public services such as housing end employment.

Getting it right The pause in the progress of the Bill gives organisations such as Mind the opportunity to ensure that, when it comes to mental health, the Government gets it right. We will continue our work with other mental health charities to ensure that ministers and MPs are made aware of our concerns and respond to them accordingly as the Bill progresses.

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update

Recognising and including dissociation and multiplicity campaign julian turner

M

arch 12th 2011 marked an historic occasion: a group of people who had received a specific diagnosis met together to compare notes and plan how to campaign for a better future. Nearly 200 people met to share experiences and plan the way ahead at the Voluntary Sector Resource Centre in London.

Dissociative identity disorder (DID) and other complex dissociative conditions are frequently misunderstood by mental health services. Unhelpful views include scepticism about the condition, ignorance about it and the causes that lead to it, misdiagnosis, lack of appropriate treatment and withdrawal of funding where supportive and effective treatment is established.

There were accounts of the problems of getting people to accept the diagnosis, how society denies the truth of people’s experience, the difficulties of studying and working with the diagnosis, self help guidance on how to live well with it, examples of the art that people who have the diagnosis make. People gave accounts about how difficult it was to get funding for appropriate treatment and of the terror that is caused by the perpetual threat to therapy through loss of funding.

People spoke of the unspeakable cruelty and abuse to which they had been subjected. There were hopeful accounts that effective therapy can lead to a full recovery.

For this group, the need to establish reliable, ongoing attachments is the key to that recovery.

Unfortunately, there is a lack of real

knowledge about the problems it poses for people, which include losing time, isolation and collapse of personal worlds. It is also hard to find sympathetic professionals who listen attentively and believe what they are told.

Organised by the Clinic for Dissociative Studies, First Person Plural (a survivor-led charity for people who experience dissociation), the Bowlby Centre, the Trauma and Abuse Group (TAG) and Partners of Dissociative Survivors (PODS), this day marks the start of a campaign to improve circumstances for people who experience dissociative symptoms. The contributors hope that it will begin a re-appraisal leading to a better understanding that dissociation is a creative response to unbearable trauma, not a disorder at all.

Immediate goals include: • Ensuring treatment for dissociative responses are covered by NICE Guidelines • Ensuring that GPs have a system ‘code’ for DID • Challenging the current move to re-classify DID as a ‘borderline personality disorder’: survivors wish it classified as an aspect of post-traumatic stress • Improving training for healthcare professionals • To classify DID assistance-dogs similarly to hearing/guide dogs.

More information • Access a podcast of the event: email dr-amelie-roberts@hotmail. co.uk

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