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SWUF A Mental Health Service User Group

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Title: SWUF A Mental Health Service User Group


1
SWUF A Mental Health Service User Group
  • Presented by Michelle Evans, Theresa Jones,
    Holly Potter, Selina Rawicz, Josh Sklar, Bethan
    Smith and Rachael Turner.

2
  • Mental illness is very common. About one in
    four people has this diagnosis, but there is a
    great deal of controversy about what it is, what
    causes it, and how people can be helped to
    recover. People with a mental illness can
    experience problems in the way that they think,
    feel or behave. This can significantly affect
    their relationships, their work, and their
    quality of life. Having a mental illness is
    difficult, not only for the person concerned, but
    also for their family and friends. Mental
    illnesses are some of the least understood
    conditions in society. Because of this, many
    people face prejudice and discrimination in their
    everyday lives. However, unlike the images often
    found in books, on television and in films, most
    people can lead productive and fulfilling lives
    with appropriate treatment and support. For some
    people, drugs and other medical treatments are
    helpful, but for others they are not. Medical
    treatment may only be a part of what helps
    recovery, and not necessarily the main part. It
    is important to remember that having a mental
    illness is not someone's fault, it is not a sign
    of weakness, and is not something to be ashamed
    of. Seeing someones problem solely as an
    illness that requires medical treatment is far
    too narrow a view. It discourages people from
    thinking about the many different influences on
    someone's life, on their thoughts, feelings and
    behaviour, which can cause mental distress. It
    may also prevent people from exploring the
    various non-medical treatment options that are
    available. For these reasons, some people prefer
    to talk about mental or emotional distress,
    rather than mental illness MIND Website

3
Overview
  • Introductions
  • The Medical and Social Model
  • Labels/ Stigma
  • Back to the future?
  • Paws for thought

4
Introductions
  • Why the mental health user group?
  • Personal and professional interests
  • A short exercise
  • Why is SWUF different from the other service user
    groups?
  • Power and autonomy

5
  • Ideas of normality Goffman and social
    interactions
  • An example
  • Visibility and the disabled peoples movement.

6
Introduction cont
  • Introductions to SWUF
  • The importance of a voice

7
  • Who attended?
  • Lots of diversity (?!)
  • Terms used
  • Service User
  • Mental illness
  • What was decided in regards to these terms and
    why?

8
  • Exercise and the term brainstorming
  • Why this was positive, implications for the
    service user and us as social workers.

9
Mental Health/illness
  • Not Illness prefers the terms disorder/
    emotional distress/ emotional dysfunction/ mental
    disability
  • Schizophrenia/ Bi-Polar/ Neurotic/ Psychotic/ OCD
  • Survivors/ just getting by as opposed to
    living
  • Repression/ stigma/ social exclusion, i.e
    employment jury service/ marginalized/ stressful
    scenarios/ enclosure

10
Mental Health/IllnessContinued
  • Lack of concentration
  • Labelling
  • Media negative/ violence/ fear/ psychopath/
    mad/ wrong impression/ wrong perception
  • Action groups set up to counteract effects of
    media/ MIND
  • Education required in order to change attitudes

11
Social Work
  • Busy bodies/ nosy parkers/ separating families/
    needy people (service users)/ friction (-)
  • Reactive (-)/ radical activists (/-)
  • Practical help/ supportive/ friendly/ regular
    contact/ compassionate/ caring/ empathetic/
    befriender/ human/ mutual respect /role model/
    genuine/ advocate ()
  • Going beyond the call of duty/ parameters set ()

12
How People Treat You
  • Employment discrimination against/ catch 22
    tell them about your illness no job or not tell
    them and risk being found out, then sacked for
    lying
  • Need to prove yourself even before being given a
    chance
  • Form filling
  • Shabby/shoddy treatment oppression

13
How People Treat YouContinued
  • Labelling can be due to type of medication
  • Medical model rather than holistic approach
  • Distorted in the media/ film people feel like
    they know you and your problems as a result
  • Made a joke out of/ stigma ignored by
    psychiatrists

14
How You Would Like to Be Treated
  • With empathy/ respect/ equality/ compassion/
    care/ professionalism/ as an individual
  • Being given opportunities, e.g MIND/ empowered/
    heard by appropriate people/ accepted socially
  • Have suitable housing/ accessible transport
  • Live in a therapeutic environment

15
Medical and Social perspectives in Mental Health
  • Looking at Service Users experience of medical
    and social intervention
  • By talking to Service Users in group and as
    individuals in one to one meetings
  • Highlighting group and individual perceptions of
    their care/treatment programmes
  • Relating their experience to medical and social
    models of caring for people with mental health
    problems

16
Medical and Social perspectives in Mental Health
(Service users perceptions of medical
intervention)
  • Emphasis on medical treatment (medication, ECT)
  • Not happy with Side effect of medication
  • Power of diagnosis (labelling)
  • Understanding of the diagnosis
  • Coming to terms with diagnosis and coping with
    stigma

17
Medical and Social perspectives in Mental Health
(Service users perceptions of Social intervention)
  • Social Workers are busy bodies, nosey parkers and
    they separate families
  • Not much understanding of Social Workers role
  • Not as easy to get help from a Social Worker as
    it is from Health Professionals
  • Those with Social Workers have a better
    perception of what they do and are more positive
    about the help they receive

18
Medical and Social perspectives in Mental Health
(medical model)
  • Long history, Early days of incarceration and
    separation from society with little in the way of
    treatment, latter on ECT and surgery
  • More recently based with biological intervention
    of treating the symptoms with drugs (and
    sometimes ECT) with a view to stabilising their
    condition and moving them back into the community
  • Still involuntary admission and treatment orders
    under the Mental Health Act (1983)
  • Medical model still dominant

19
Medical and Social perspectives in Mental Health
(social model)
  • The focus is on understanding mental illness
    within the social context of individuals
  • Sees interpersonal relationships as explanations
    of behaviour rather than isolate the individual
    from family and environment
  • Looks for explanations for psychiatric breakdown
  • Working with the person and educating them and
    their families to help them live within society
  • Offers an alternative to the purely medical model

20
Medical and Social perspectives in Mental Health
(Social and medical intervention and support)
  • Health and Social Services work in partnership
    with each working from their own theoretical base
  • Medical staff from the nurse to the psychiatrist
    treat mental illness in the same way as physical
    illness
  • Diagnosis, psychotropic medication, TLC,
    monitoring recovery
  • Behavioural/cognitive therapy from psychologist
    and Occupational Therapy to improve deficits in
    personal, social and economic functioning

21
Medical and Social perspectives in Mental Health
(Social and medical intervention and support)
  • Social Workers meet with families as well as the
    person giving a social biography to help in
    diagnosis
  • Are a link between the hospital and
    friends/relatives helping them cope
  • Co-ordinate the provision of care including
    health, housing, income, occupation and social
    inclusion
  • Educate about diagnosis, prognosis and treatment
    including coping with side effects of drugs
  • Planning care around changing needs

22
Medical and Social perspectives in Mental Health
(Social and medical intervention and support)
  • Improved treatment of people suffering from
    mental illness over the years
  • New partnerships provide continuity of care
  • Gradual education of others in society to
    alleviate labelling and stigma
  • Society still will not tolerate the behaviour
    which is sometimes displayed by people suffering
    from mental illness

23
Exercise
  • M is a 36 year old woman who has had experienced
    a long period of domestic violence spanning some
    20 years. After fleeing her family home she took
    refuge in a womens shelter in another city.
    Staff at the shelter became increasingly worried
    about her erratic behaviour and the unruliness of
    her two children. Social Services were informed
    and the children were placed into voluntary
    foster care. M was diagnosed as bi-polar (manic
    depression). Six months on and M is feeling
    better, but continues to live in the shelter, and
    her children are still in foster care.
  • How can we help M to get her life back on track?
  • Consider what obstacles M may encounter in this
    process.

24
Mental Health
  • Media and Stigmatisation

25
What SWUF said
about the media
To what extent is the media responsible for
negative perceptions and the stigmatisation of
mental illness?
26
What the literature says
  • Those with Mental Illness in the media are
  • Considered a danger to themselves
  • Considered childlike unable to care for
    themselves
  • Portrayed as different and terms used include
    psychotic and unstable
  • Depicted as
  • Dangerous and unpredictable
  • Unsociable
  • Unemployed
  • Transient
  • Sensational, vivid stereotypical language is
    used

27
What the research says
  • Signorielli (1989) 72 of characters on USA TV
    with MI were depicted as violent compared to 42
    of normal characters
  • Rose (1998) two thirds of people with MI were
    portrayed as violent in British TV news stories
  • Wahl (2000) with reference to 107 magazines
    depicting Obsessive Compulsive Disorder over 15
    years, only one third portrayed the condition
    accurately

Negative and unbalanced media coverage
28
The consequences
STIGMATISATION!!!
  • Wahl (1999) Stigmatisation is detrimental to
    the well-being of persons with mental illness
    discrimination
  • 1300 people questioned reported stigmatisation
    left them discouraged, hurt, angry and lowered
    their self-esteem
  • Others treated them as less competent
  • MIND questioned 515 people suffering from MI
  • 73 said coverage unfair, unbalanced or very
    negative
  • 50 said coverage had negative effect on their
    mental health
  • 25 said neighbours behaved in hostile manner due
    to media

Poor, unbalanced press coverage of mental health
issues fuels stigma and reduces quality of life
for sufferers (MIND)
29
Wot the Sun said
  • What MH groups said
  • Belongs to an era when Mental patients were
    locked up like animals
  • Ignorant reporting
  • Insult to Bruno thousands of people who endure
    MI
  • Reporting reflected prejudice against mental
    illness throughout society Dr Liam Fox

MIND SANE called for a more mature, sensitive
understanding approach to mental illness
30
Power WITH responsibility
  • Service User group identified a need for more
    positive, informative and educational media
    coverage
  • Important because, lacking direct experience,
    media is opinion-former
  • Media DOES have power to inform, educate and
    raise awareness
  • Cathy Come Home
  • Amnesty International
  • More SUs working with media than ever before
  • Debate and discussion is helpful

31
A positive way forward
The Changing Minds campaign was launched to
inform the media and public, and tackle stigma
(changingminds.co.uk)
A London Underground poster
32
FILM GOES HERE
33
Changing Minds Campaign
34
(No Transcript)
35
Access to Employment for people with
Mental Health problems.
36
I hope we all agree that .
  • It is extremely unjust, a waste of human
    potential, a great cost to society, and unlawful
    to exclude anyone from employment simply because
    that person had experienced or experiences mental
    health problems.
  • http//www.dh.gov.uk/assetRoot/04/06/03/81/0406038
    1.pdf

37
However
  • discrimination in the workplace is one of the
    greatest barriers to social inclusion.
  • Unemployment affects those with long- term mental
    health problems more than any other groups of
    people with disabilities (ONS 1998).
  • Only 13 are in employment compared to over a
    third of people with disabilities generally.
    (Labour Force Survey 1997/98)

38
Experience of Service Users as expressed
throughout consultation
  • At least four of the service users felt that
    their mental health problems affected access to
    employment.
  • At least two clients felt that they had been
    actively discriminated against in their
    workplace.
  • There were occasions when clients were turned
    down for internal jobs they applied for. It was
    later discovered that the rejection was due to
    concerns of previous hospitalisation of the
    applicant.

39
  • One client stated that when they were first ill,
    they wanted to work but
  • The psychiatrist told them to take a couple of
    years off and to treat it like a holiday. The
    client has done so ever since.
  • The client had got used to psychiatrists making
    lots of decisions for them and expects
    psychiatrists to make decisions for them about
    going back to work.
  • The client would like the government to push
    them back to work so that they at least know if
    they will be able to deal with it.

40
  • At least one client felt that if they were to
    start working again, they could take or need less
    medication.
  • However, it was also stated that the medication
    drains away the incentive to work and they would
    be more motivated if they were on less
    medication.
  • One client cited an occasion when their Community
    Psychiatric Nurse came to their workplace to give
    them an injection and their employer found out
    that they suffer from mental health problems and
    consequently moved then to an easier job.

41
  • One participant had raised the issue of the
    Disability Working Allowance to a prospective
    employer. He was not successful in getting the
    job and thought this might be because he was
    discriminated against.
  • One service user stated that most survivors who
    are in paid employment work in the mental health
    field.

42
Access to Education
  • At least one service user felt they had been
    discriminated against at a local college when the
    tutor on a computer course thought they were just
    lazy and that their mental health illness was an
    excuse and this has put them off education
  • Whereas at least one other participant attended
    a very supportive college and was the source of
    much of their social life.

43
The strategies used to cope with discrimination
in access to employment
  • Not declaring that they had been previously
    hospitalised due to mental health problems or
    that they had a mental health problem at all.
  • At least one client described a Catch 22
    equation regarding employment,
  • Tell them (potential employer) about your
    illness means no job or not tell then and risk
    being found out, than sacked for lying

44
  • One service user did not tell their employer of
    their medical health problem and tried to keep
    this concealed. This led to increased paranoia
    and stress which induced schizophrenic symptoms .
  • Ultimately they had to stop going to work. The
    service user stated that they would avoid this in
    the future and would like to find a job with an
    employer who is sensitive to those suffering from
    mental health problems.
  • The service user would like to get a job as a
    support worker with people with mental health
    problems but is waiting for a time when they feel
    more prepared and able.

45
Disability Discrimination Act 1995
  • The employment provisions of the Disability
    Discrimination Act came into force Dec 1996
  • Under the Act , it is unlawful for most employers
    to treat a disabled person less favourably then
    someone else because of his or her disability
    without justification, or fail to comply with a
    duty upon them to make reasonable adjustments
    without showing that the failure is justified.

46
  • One of the definitions of disability the Act
    works with is that a disabled person is someone
    who at the relevant time has a physical or mental
    impairment.
  • The Act does not include any impairment resulting
    from or consisting of a mental illness unless it
    is a clinically well- recognised illness.
  • Examples of conditions include depression,
    schizophrenia, dyslexia, bi- polar (manic
    depression) and learning disabilities.

47
Moving forward
  • It is suggested that what is needed is for all
    employers, not just the public sector, to commit
    to anti- discriminatory principles.
  • http//www.dh.gov.uk/assetRoot/04/06/03/81/040603
    81.pdf
  • It must include the commitment that this type of
    discrimination is taken seriously and will be
    eradicated.
  • Mental health should not be the cause of derision
    or ridicule and people with mental health
    problems have the same right to be treated fairly
    and with respect as everyone else.

48
  • Some of the main issues identified are tackling
    discriminatory attitudes within the workplace and
    issues of confidentiality.
  • http//www.dh.gov.uk/assetRoot/04/06/03/81/040603
    81.pdf

49
Employer Case Study
  • The NHS are described as taking a lead role in
    anti- discriminatory access to employment for
    people with mental health problems incorporated
    in, Mental Health Issues in Employment.
  • This guidance aims to address the management of
    mental health issues in employment, raising
    awareness among staff and reasons for employing
    people with mental health problems.

50
Reasons for Employing People with Mental Health
Problems
  • reasons cited for employing people with mental
    health problems was based on the skills and
    experience gained throughout the course of their
    illness and how these skills could be used to
    improve the quality of the mental health services
    offered.
  • These are valid claims and it is often the case
    that those suffering or who have suffered with
    mental health problems go onto roles where they
    can support others with mental health problems.

51
However
  • it can argued, that this is not anti-
    discriminatory or inclusive. Is it enough to say
    these people are useful in the mental health
    arena only?
  • Reasons to employ people should not be based on
    their experiences as a sufferer of mental health
    problems alone but on individual ability and
    rights to employment.

52
The Role of Social Work in Mental Health
  • Mental Health Act 1983 introduced the Approved
    Social Worker (ASW) role
  • By the end of the 1980s, Community Mental Health
    Teams were set up these brought social workers
    and mental health professionals under one roof.
  • Proposal to replace the ASW post with an Approved
    Mental Health Professional (AMHP), this post will
    straddle both health and social care

53
The Way Forward
  • The Department of Health policy guidelines 1999 -
    those people who use mental health services
    should be involved in the planning and delivery
    of care that they receive.
  • Service user involvement can take a number of
    forms,
  • as a recipient of communication subject of
    consultation and agent in control, with levels of
    interaction between fellow service users, between
    user and professionals, management of local
    services and planning of overall services. (Peck
    et al (2002))
  • Hickey (1998) identified a participation
    continuum which included information/explanation,
    consultation, partnership and user-control.

54
The Way Forward continued ..
  • Service user involvement is imperative as
  • Bracken Thomas (2001) Double (2002), and Smail
    (1993) all recognised that our current
    understanding of psychological distress is
    partial and limited.
  • With the introduction of the Mental Capacity Act
    2005, it is felt that the needs of the service
    user will be better met.
  • Harper (2002) advocated moving away from the
    tyranny of expert knowledge.
  • Beresford (2000) felt that the inclusion of
    service user groups in training was imperative
    for the future of social work.

55
Back to the Future
  • Mental Health - implications for the 21st
    century

56
The Mental Health Bill
  • Defines when and how individuals diagnosed
    with a mental health illness can and should be
    treated without their consent.
  • Treatment without consent should only be
    administered if absolutely necessary.
  • Treatment should be explained to the patient.

57
Mental Health Bill cont
  • Mental Health Advocacy Service to be set up under
    the terms of the Bill.
  • Allows for Service Users to choose a nominated
    person to vouch for them.
  • This does not need to be a health professional.
  • Social Worker role is limited and sparsely
    referred to.

58
What the critics say
  • Emphasis within the Bill is on the avoidance of
    risk rather than providing benefit through
    appropriate treatment interventions. (S. London
    Maudsley NHS Trust)
  • Mental Disorder and Medical Treatment
    definitions too broad. (S. London Maudsley NHS
    Trust)
  • Mental Health User groups agree.
  • a public order Bill dressed up as mental health
    legislation.

59
What the critics say cont
  • Mental Disorder and Dangerousness reinforcing
    the stigma.
  • It risks substantially increasing the
    stigmatisation of a vulnerable group, contrary to
    the entire thrust of current mental health and
    social care policy (South London Maudsley
    NHS Trust)

60
Social Workers and the Mental Health Bill
  • No power to singularly veto the use of
    compulsion.
  • Constrains the independence of the Approved
    Social Worker role.
  • Approved Mental Health professionals might
    replace Approved Social Workers.

61
Employment and Mental Health
  • Less than 4 out of 10 employers would knowingly
    employ an individual with a mental health
    condition. (The Social Exclusion Report 2004)
  • People who experienced mental distress have the
    highest rate of unemployment amongst people with
    disabilities.
  • Only 19 are employed.

62
Progress?
  • Very little increase in the past 10 years in
    adults with neurotic or psychotic disorders in
    the labour force. (Mental Health and Soc.
    Exclusion Report)
  • Over half of respondents in a survey commissioned
    by the Office for National Statistics believed
    they had definitely or possibly been turned down
    for a job due to their mental health problems.
  • Most did not feel confident disclosing their
    experience of mental health problems on job
    application forms.

63
Some good news
  • Mental Health and Social Exclusion Project
    outlines Govt. commitment to-
  • Reduce social exclusion among adults with mental
    health problems.
  • Prevent these individuals from falling out of
    the labour market.
  • To ensure they enjoy and have access to the same
    opportunities for social participation and
    access to services as the general population.
  • Working with Service user groups.

64
Thank you for listening!!
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