Changing practice and service development implementing the SEU report, implications and expectations

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Changing practice and service development
implementing the SEU report, implications and
expectations for modernised day services

• David Morris
• Programme Director,
• National Social Inclusion Programme
• National Institute for Mental Health in England

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Social Exclusion Unit Mental Health Project
- remit and time scale

• How to enable more adults with mental health
  problems to enter and retain work?
• How to enable social participation and access to
  services?
• Feb 03 to Mar 04 consultation - users,
  organisations and Ministers
• Publication June 04 implementation from Sept
  04

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Social exclusion defined

• What can happen when people or areas suffer from
  a combination of linked problems unemployment,
  poor skills, low incomes, poor housing, high
  crime, bad health and family breakdown.
• Characterised by the inter relatedness of
  problems that are mutually reinforcing combined
  they create a fast moving, complex and vicious
  cycle
• (Social Exclusion Unit 2004)

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www.socialexclusionunit.gov.uk Tel [phone]
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Inclusion - the Ministerial vision

• Social Inclusion for people with mental
  health problems is a moral imperative
• (Rosie Winterton Minister for Health,
  launching SEU report June 04)
• Our vision is a future where people with
  mental health problems have the same
  opportunities to work and participate in their
  communities as any other citizen
• (SEU Report p94)

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Less than 40 of employers wouldrecruit people
with mental health problems
Two thirds put off applying for jobs for fear of
unfair treatment

• but many ...
• highly skilled
• relevant experience
• able to work with minimal adjustment

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Less than a quarter of adults with mental health
problems are in work

• Main barriers
• fear of losing benefits
• employers attitudes
• fluctuating nature of condition
• low expectations of health professionals

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People are excluded in many different ways
serious illness overlooked
low levels of participation in FE/leisure
activities
harassment complaint not taken seriously
not eligible to be juror or school governor
1/4 tenants with serious arrears/at risk of
eviction
financial services hard to access
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People can become very isolated
Services
Employment
?
?
?
Sport/ exercise
?
?
Education
?
?
Family/ neighbourhood
Volunteering
Faith communities
Arts and Culture
Sue attends the day centre and the clinic. She
has 5 friends she sees at outpatients or the day
centre
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Action plan - six main themes

• stigma and discrimination
• sustained programme to challenge discrimination
  5-year plan launched by Rosie Winterton on 23
  June
• practical teaching resources for schools and
  monitoring of broadcast
• media with Ofcom
• promoting best practice in the public sector
• role of health and social care services
• implementing evidence-based practice on
  employment, working towards an employment adviser
  for everyone with severe mental health problems
• improved access in primary care to advice on
  employment and community activities
• changing day services so they help people to do
  things in their community
• strengthened training on social inclusion

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Action plan - six main themes (2)

• employment
• improved training on mental health issues for
  Jobcentre Plus staff
• 1.5m from the Phoenix Fund to support people
  interested in self employment / enterprise
• clarifying benefit rules for people wanting to
  return to work
• improved support for employers and job retention
• supporting families and community
  participation
• targeted family support for parents with mental
  health problems and their children
• improved support to access education and training
  opportunities
• removal of unnecessary barriers to community
  roles such as jury service

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Action Plan - six main themes (3)

• getting the basics right
• - new guidance to housing authorities to prevent
  unnecessary evictions
• - improved access to financial and legal advice
  and affordable transport
• making it happen
• implementation programme with ministerial
  oversight
• - cross-govt team
• - independent advisory group to advise govt.
  on progress
• - local implementation led by PCTs and Local
  Authorities
• - effective use of voluntary and community
  sector

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Why is this report so important?

• establishes action on inclusive practice as a
  moral imperative, underpinning citizen rights
• calls for balanced action on the multiple impact
  of exclusion on employment and wider aspects of
  participation
• supports action on inequalities by making
  inequity of access and participation an
  equalities issue
• demands attention as much to the mainstream the
  ordinary as the specialist centralises the role
  of primary care as setting for vocational advice
• signals need for cultural shift both in and
  beyond the service system
• Recognises that inclusion is effect and cause in
  stigma and discrimination

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National Social Inclusion Programme

• Capacity 3 key sources
• Central cross govt. multi-agency team
• Regional SI resources SI leads and local
  projects/people
• Affiliates network 40 User/NGO/Professional
  orgs
• Content
• 8 major projects, each led by DC with central
  support
• 5 cross cutting work streams, led by central team
• Governance
• Cross govt network key officials
• Independent Advisory Group reports to Ministers
• SEU monitoring team

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Programme Delivery - leadership integration,
accountability for corporate programme
goals NATIONAL CROSS - GOVERNMENT IMPLEMENTATION
TEAM Project Support Leading cross-cutting action
Programme Delivery - locality of corporate
programme goals DEVELOPMENT CENTRES - Project
Leadership DC 1 DC2
DC3
DC4 DC5
DC 6
DC7 DC8 SW
SE LON
EM
NE,YH NW
WM E

Project 1 Stigma Discrimination (Delivery by
SD prog)
Project 2 Employment
Project 3 Income Benefits
Project 4 Education
Project 5 Housing
Project 6 Community Participation
Project 7 Social Networks
Project 8 Direct Payments
cross cutting action themes Workforce Development
Research Evidence Community
Engagement Criminal Justice Tackling
Inequalities
Affiliated Organisations - NGOs x 20 - 25
Project Teams

• Management Delivery
• Service User organisation rep
• Development Centre SI Lead
• National Implementation team rep
• Affiliate organisation(s)

• Support Stakeholder
• Good practice networks
• Affiliate organisation(s)

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Early progress

• Includes
• Commissioning guidance in preparation
• - day services modernisation
• - employment
• Direct payments guidance completed
• DfES advice to Learning and Skills Council on MH
  issued
• Project teams and plans x 8 in place
• National New Ways of Working guidance to
  support S.I. agreed

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Inclusion, barriers and challenges

• growing the evidence base realistically to
  support measurement and monitoring of progress
• making the link between MHP and MH Services stick
  - moving on from silos to cross - boundary,
  work in the ordinary world
• challenging cynicism inclusion being seen as the
  softener for MH Bill
• capacity for organisational change at local level
  
• sustaining cross - government action nationally

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Barriers and challenges 2

• embedding creative practice in organisations not
  just individuals
• developing primary care and re - equipping social
  care making it a commissioning priority
• exploiting opportunities for community level
  action and engagement afforded by local
  regeneration and Local Strategic Partnerships
• making inclusive practice and culture a
  mainstream aspect of service organisation at
  heart of leadership and workforce development
  agendas for all professional and non - aligned
  groups
• day services transformation - a major challenge

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The day services agenda post SEU

• to
• transform day services into community
  resources that promote social inclusion through
  improved access to mainstream opportunities

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Key objectives for day services

• To provide for
• access to community opportunities
• person centred provision irrespective of
  severity
• clear links to community services and partner
  agencies
• befriending, advocacy and support to enable local
  service access
• service user involvement in service design and
  delivery
• achieving social inclusion and employment
  outcomes

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Dimensions of a modernised day service

• supports recovery
• portal to mainstream activity
• not principally a bricks and mortar enterprise
• specific to needs and aspirations of individual,
  but
• builds the community capacity necessary to their
  achievement through
• alliances and partnerships beyond the MH system
• community engagement for community bridge
  building

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New day services opportunities

• new focus on policy neglected area
• resource potential, sometimes from mixed funding
  sources
• staff skills base extensive experience of
  severe need and rehabilitation objectives
• familiarity with carer and some social networks
• may have rich community links and effective
  inter-agency relationships

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New day services - risks

• loss of staff skills
• insensitive pace of change
• poor engagement with developing replacement
  services
• inadequate attention to specific personal need
  and/or preference
• neglecting importance of internal social networks
• loss of public confidence in service

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Inclusive practice means working inclusively
together

• Thank you
• david.morris_at_dh.gsi.gov.uk