Changing practice and service Changing practice and service development development

– implementing the SEU report, – implementing the SEU report, implications and expectations for implications and expectations for

modernised day servicesmodernised day services

David Morris

Programme Director,

National Social Inclusion Programme

National Institute for Mental Health in England

Social Exclusion Unit Social Exclusion Unit Mental Health Project - remit and time scale 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

Social exclusion definedSocial 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)

www.socialexclusionunit.gov.ukTel: 0870 1226 236

Inclusion - the Ministerial visionInclusion - 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)

Less than 40% of employers wouldLess than 40% of employers wouldrecruit people with mental health problemsrecruit people with mental health problems

8878

62

37

0

50

100

% of employers who would recruit from different groups

ONE evaluation (DWP 2001)

lone parentslong-term unemployedphysical health problemsmental 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

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

Main barriers

• fear of losing benefits

• employers’ attitudes

• fluctuating nature of

condition

• low expectations of health

professionals

LFS data for England only

0

10

20

30

40

50

60

70

80

1998 1999 2000 2001 2002 2003

whole populationphysical health problemsmental health problems

People are excluded in many different waysPeople are excluded in many different ways

low levels of participation in FE/leisure activities

serious illness overlooked

not eligible to be juror or school governor

financial services

hard to access

harassment complaint not taken seriously

1/4 tenants with serious arrears/at risk of eviction

Employment

Education

Volunteering

Arts and Culture

Faith communities

Family/ neighbourhood

Sport/ exercise

Services

Sue attends the day centre and the clinic.She has 5 friends she sees at outpatients or the day centre

People can become very isolatedPeople can become very isolated

Action plan - six main themesAction 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

Action plan - six main themes 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

Action Plan - six main themesAction 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

Why is this report so important?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

National Social Inclusion ProgrammeNational 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

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,Y&H NW WM E

cross cutting action themes

Workforce Development Research Evidence Community Engagement Criminal Justice Tackling Inequalities

Affiliated Organisations - NGOs x 20 - 25

Project 1

Stigma & Discrimination

(Delivery by S&D prog)

Project 3

Income & Benefits

Project 4

Education

Project 5

Housing

Project 6

Community Participation

Project 7

Social Networks

Project 8

Direct Payments

Project 2

Employment

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)

Early progressEarly 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

Inclusion, barriers and challengesInclusion, 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

•

Barriers and challenges Barriers and challenges 22

• 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

The day services agenda – post SEUThe day services agenda – post SEU

to:

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

Key objectives for day servicesKey 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

Dimensions of a modernised day serviceDimensions 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

New day services – opportunitiesNew 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

New day services - risksNew 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

Inclusive practice means working Inclusive practice means working inclusivelyinclusively together together

Thank you

david.morris@dh.gsi.gov.uk