Module 6:

Developing socially inclusive practice

Module 6

The Ten Essential Shared CapabilitiesLearning pack for mental health practice

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TheTenEssentialSharedCapabilities

Module6:

Developingsociallyinclusivepractice

Module6exploresthelinkbetweenTheTenEssentialSharedCapabilitiesanddevelopingsociallyinclusivepractice.

Aftercompletingthismodule,youwillbeableto:

Challengetheprocessesthatleadtoinequalityandexclusion;Adoptassessmentsandinterventionsthatareinclusion-focusedanduser-centred;Understandtheimportanceofworkinginpartnershipwithmainstreamcommunityorganisations.

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Contents

.INCLUSIONWhatdoesinclusionlooklike?............................................................... 2

2.ASSESSMENT-Yourfocusandyourapproachtoassessment............................. 4

3.EXCLUSION-Theprocessesandpowerofexclusion................................................ 8

4.COMMUNITY-Workingbeyondthementalhealthservice................................... 0

5.FOCUS-Gettingandkeepinginclusion........................................................................ 3

6.EMPOWERMENT-Unfinishedbusiness......................................................................... 6

7.Linkstofurtherlearning...................................................................................................... 8

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.INCLUSIONWhatdoesinclusionlooklike?

Activity6.

Writedownthethingsthatenrichyourownlife;thingsthataresoimportanttoyoupersonallythattheygivelifeasenseofmeaningandvalue:

Nowmoveontocreatealistofyourfeelingsandactionsif:

Oneormoreoftheseweremissing(imaginelosingyourhomeoraclosefriend):

Youhadtofaceseriousproblems(suchasmajorillness,abereavement,redundancy)intheabsenceofthesethings:

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Thesocialinclusionagendarequiresmentalhealthservicestopayattentiontomanyofthesethingsthatmakeliferewarding.Theyarenotjustitemsonalistofpre-disposingfactors,socialcircumstancesortopicsrestrictedtomentalhealthpromotionspecialiststheyarecriticaltorecovery.

ESC4(ChallengingInequality)expectsstafftobeactivelyinvolved(noticetheactionwords)inchallenginginequality,addressingdiscriminationandcreating,developingandsustainingvaluedsocialrolesforserviceusers.

Onecatchphraseoftheinclusionmovementisseparatecannotbeequal(Sayce2000).Thischallengesthehistoricalpracticeofdevelopingaparallelworldofsegregatedservicesformentalhealthserviceusershomesforthementallyill,shelteredworkshops,separatecollegeclassesandcreativewritinggroupsforsurvivorsofthementalhealthsystem.Instead,mainstreamcommunityorganisationsshouldberedesignedforeveryone,andthatincludespeoplewithmentalhealthneeds.

Mentalhealthspecialistsshoulddelivertheirexpertsupporttopeopleandcommunitiesinwaysthatassistthemtogetandstayconnectedwiththewidercommunity.Onthosefewoccasionswhenseparateservicesarejudgednecessary,theyshouldbetransformedintostepping-stonestoinclusion,notdeparturepointsforexclusion(Dunn999).

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2.ASSESSMENT-Yourfocusandyourapproachtoassessment

Forthispartofthemoduleyouwillneedtoobtainastandardassessmentformthatisusedinyourservice(perhapsaspartoftheCareProgrammeApproach).

Thegovernmenthasprovidedclearguidanceaboutassessment,butdespitethis,localdocumentsoftenneglecttheinclusionagenda.

Activity6.2

Takeafewmomentstoreviewablankassessmentforminuseinyourlocalserviceagainstthefollowingchecklist:

Isthereaclearspacetorecordthepersonsownviewpoint,orisithiddenbehindphraseslikeagreedactionplan?(SeeESC3PractisingEthicallyandESC7ProvidingServiceUserCentredCare)

Doestheformidentifyeveryonewhocaresabouttheperson?Noticethatthisquestionisaboutcaringaboutafreelygiven,emotionalresponsetothepersonasawholeratherthancaringforwhichisaboutmeetingneeds(SeeESC4ChallengingInequality)

Doestheformgivespacetoexplorewhatisworkingandwhatisnotworkingaboutthepersonshomelife,occupation,relationshipsandleisure?(SeeESC6IdentifyingPeoplesNeedsandStrengths)

Wouldacompletedformgiveyouinsightsintothepersonshistory,long-termsenseofwhatgiveslifemeaning,andtheirhopesforthefuture?(SeeESC5PromotingRecoveryandESC6-IdentifyingPeoplesNeedsandStrengths)

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Goodorganisationcanhelptokeepusontherighttrack,butsometimesthecultureofamentalhealthservicehighlightsotherpriorities.Pressureofwork,respondingtocrisesanddefensivepracticecanallnarrowthefocus.Restoringasocialinclusionfocus(Bates2002)maydemandactioninallthefollowingareas:

Narrowedfocus Asocialinclusionfocusaddsthefollowingdimensions:

Reviewthisbyexaminingyourworkwithoneserviceuser

Stateofthepersonsmentalhealthasauserofmentalhealthservices

Thepersonspositivesocialroles,suchashouseholder,employee,parent,friend.

Doesthecareplanincludeactionstosupportthepersonintheseroles?

Respondingtocrisisandcopingwithtoday

Thepersonsambitionsandgoalsforthefuture

Aretherapeuticinterventionsdesignedtoassistthepersontoidentifyandmovetowardstheirpreferredlifestyle?

Thepersonasarecipientofhelp

Thepersonasacontributortosociety

Whatopportunitiesdoesthepersonhavetoenrichthelifeofotherpeople?

Communityorganisationsthatofferhelp

Communityorganisationsthatofferpositivestatusandrolesoutsidethementalhealthservice

Dothepeoplecontactedbythecareteamrepresenthelpingorcommunityorganisations?

Growingstrongteamswithinthementalhealthservice

Buildingnewalliancesbeyondthementalhealthservice

(Thinkingbeyondthisoneserviceusernow)Howmuchstafftimeisring-fencedforspendingwithpeoplefromnon-mentalhealthagencies?

Whatwereyouranswerstothequestionsintheright-handcolumnabove?

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Activity6.3

Writedownsomewaysthatyoucouldbemoresociallyinclusiveintheworkyoudo:

Beforeweleavethissectionweneedtothinkabouttwospecificgroupsofpeople:

Thosewhosaytheylikesegregatedserviceswheretheyaresurroundedbyothermentalhealthserviceusersandstaff.Theysimplypreferadaycentretoajob,amentalhealthclasstoamainstreamclass,ahospitalwardtohometreatment.

Thosewhoareconsideredtoneedsegregatedservicesfortheirownorotherpeoplessafetyortogivethemthetimeandspacetorecover(e.g.inatherapeuticcommunity).

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Activity6.4

Howdopeoplegetintothesegroups?Considertheinfluenceof:

thepersonthemselfrelativesandfriendsschoolsandcommunityorganisationshealthandsocialcareservicespoliceandcriminaljusticeagenciesgeneralpublicandthemedia

Whatwouldhelppeopletogetoutofthesegroups?

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3.EXCLUSION-Theprocessesandpowerofexclusion

Inordertocombatsocialexclusion,weneedagoodunderstandingofhowitworksinsocietyandaffectsindividuals(SEU2004;seealsoESC4ChallengingInequality).Thefollowingthreedefinitionsdescribedistinctbutinter-relatedelements.

Inclusionasaccess.Peopleusingmentalhealthservicesshouldhaveaccesstothedecision-makingplaceswheretheirpersonalcareisreviewedandplanned;whereservicesaredesigned,managedandaudited;andwherejobsandpromotionsareoffered.

Inclusionasstandardofliving.Peopleusingmentalhealthservicesshouldhavethesameopportunitiesasothercitizenstoenjoyemploymentandincome,healthcare,housingandcommunitysafety,civicandlegalrights.

Inclusionasrelationships.Peopleusingmentalhealthservicesshouldhavethesameopportunitiestoestablishandmaintainrespectfulconnectionsandfriendshipswithadiversearrayofothercitizens.(Bates2002)

Considerthefollowingcaseexamplesinturnandbuildupadetailedstoryofatypicaljourneyintoanexcludedlifethatmightbeexperiencedbyapersonfromthefirstonsetofmentaldistress(Mind999).Activity6.5

Considerhowthethreeaspectsofinclusionlistedaboveimpactonthepersonslifeandbecomemutuallyreinforcing.

Dofactorssuchasage,genderorethnicityaffectthejourney?(SeeESC2RespectingDiversity).

Domentalhealthservicessometimesmakeexclusionworse?

Whatdotheseservicesdotohelpthereturnjourney?

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Neetabecamesuicidalsoonafterthebirthofherfirstchild.Herpotentialjourneyintoanexcludedlife:

Whilstatuniversity,JasonworkedatBurgerKinguntil3amthreenightsaweek.Afterafewweeks,thedoctorwascalledtohisflat,asheseemedtobehearingvoices.Hispotentialjourneyintoanexcludedlife:

Whilsteachpersonsjourneyintoanexcludedlifeisunique,thethemesofaccess,standardoflivingandrelationshipsoftenappear.AnalternativewaytothinkaboutthisjourneywasgivenbytheSocialExclusionUnit(2004)inthefollowingdiagram.SeehowitworkswiththestoriesaboutNeetaandJasonthatyouhavejustdeveloped.

Withdrawal &rejection from society

Unemployment

Homelessness

Worseningmental health

Loss ofsocial networks

Debt

Mental healthproblems

A Cycle OfExclusion

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4.COMMUNITY-Workingbeyondthementalhealthservice

Thereareavarietyofthingsthatcanbedonetoenableapersontogetandkeeptheirpreferredlifestyleandthesewillbeexploredinsection5.Firstweneedtohelpcommunitiestobemorerespectfulandwelcomingtowardspeoplewhohaveexperiencedmentaldistress.

Theviewingpointfromwhichwelookatthewidercommunitymaybesimilartoourviewofpeoplewhouseservices.TheStrengthsModel(SeeESC6IdentifyingPeoplesNeedsandStrengths)acknowledgesthatpeoplewhouseservicesareamixturejoyanddespair,achievementanddisappointment,loveandselfishnessandthenencouragesustopayextraattentiontothepersonspositivetalentsandachievements.Indeed,someso-calledproblemsneedtoberecognizedasstrengths,especiallywhenworkingwithpeoplewhohavehadaverylengthycontactwithmentalhealthservices.Whilstitwouldbenavetothinkthatpeopleusingmentalhealthserviceshavenoproblems,thisdeliberatefocusonstrengthsisawayofrestoringbalanceinaculturethatispreoccupiedwithsymptoms,deficitsanddifficulties.Activity6.6

Describeapersonyouknowwhousesmentalhealthservicesanonymisingtheirnameandanyotherpersonaldetails:

Findallthepersonsstrengthsanduseonlypositivewordsdontsaybutordespite

Payparticularattentiontoanydifficult,antisocialorunattractivebehaviour-seekoutthestrengthsthatarehiddeninsidetheseaspectsoftheperson.Positivedescriptionoftheperson:

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Thissameviewingpointcanbeadoptedwhenfacingthecommunity.Thereisaharshrealityoutthere,ofdiscrimination,hatecrime,negativestereotypesandfearthatisdirectedtowardspeopleusingmentalhealthservices.However,thisisonlypartofthestory.Othercitizensacknowledgetheircommonhumanitywithpeopleusingservices,promoteequalityofopportunity,andofferrespectfulsupport.TheStrengthsModeldemandsthatwepayextraattentiontothepositiveaptitudesandachievementsofordinarycommunities.

Activity6.7

Consideryourownexperienceandalsofindmomentsatworktocollectpositivestoriesfromyourcolleaguesandrecordanexampleofoneofthesehere:

Whilsttherearealreadymanyalliesinordinarycommunities,agreatdealcanbedonetocreatefurtherimprovements.

Activity6.8

Selectaspecificcommunityorganisation(suchasalocalcollege,JobCentrePlusofficeoracommunitycentre)andworkthroughthefollowingquestions.

Hasyourmentalhealthorganisationidentifiedaworkertoleadliaisonwiththisorganisation,anddoyouhaveregularcontactwiththem?(SeeESCWorkinginPartnership)

Haveyoulocatedchampionswithinthecommunityorganisationwhowillsupportyoureffortstoimproveopportunities?

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Doyouunderstandthecommunityorganisationstargets,priorities,fundingregimesandpoliciesthatmayaffectopportunitiesforpeoplewithmentalhealthissues?Pleasesayalittleaboutthis.

Haveyoudeliveredinformation,trainingormentoringtopeopleinthecommunityorganisation?Pleasesayalittleaboutthis.

Haveyouseenincreasesinthenumbersandsatisfactionofpeoplewithmentalhealthissueswhoareusingthecommunityorganisation?Pleasesayalittleaboutthis.

Finallyinthissection,therearethreeoptionsfordeliveringsupport.Theseare:

Usingmentalhealthbuildingswherepeoplemeetothermentalhealthserviceusersandstaff.Thisistheoptionthatofferssanctuaryorpromotesexclusion(dependingonyourpointofview).Examplesincludehospitalsanddaycentres.

Usingbuildingsthatarealsousedbyothermembersofthecommunity,butwherethepeoplewithmentalhealthissuesremaintogetherinagroup.Thisistheoptionthatoffersgeographicalintegrationbutminimalsocialintegration.Examplesincludeseparatecollegeclassesandgrouproomshiredincommunitycentres.

Offeringcommunitybridge-buildingsupporttoonepersonatatimetoassistthemtolocateandjoinactivitieswheretheyareshouldertoshoulderwiththegeneralpublic.ExamplesincludeSupportedEmploymentandhometreatment(ESC5PromotingRecovery).

Sincemainstreamcommunityagencieshavewatchedmentalhealthservicesdelivertheirsupportlargelythroughthefirstorsecondoptions,somewillrepeatthatpatternbyofferingtosetupsegregatedservicesintheirownfacilities.Staffatthecollegeorthesportscentremayassumethatthebestwaytomeettheneedsofpeoplewithmentalhealthproblemsistocreateaspecialgroup,ratherthansupportpeopletojoininalongsidethegeneralpublic.Buildingeffectiverelationshipswithalliesinthesesettingswillhelpthemtocreateinclusiveopportunities.

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5.FOCUS-Gettingandkeepinginclusion

Acomprehensive,inclusion-focusedassessmentwillidentifythepreferredlifestyleoftheperson,asreflectedinESCs5-9.Itwillalsogosomewaytowardsidentifyingthepersonsinclusionhistoryperhapsofunsuccessfulattemptstoengageineducational,work-relatedorleisureactivities.Acknowledgingthefeelingsthatattachtotheseexperiencesandfindingthecouragetotryagainisakeypartofthejourneyofrecovery.

Sometimesitishelpfultodrawoutthelessonsthatcanbelearntfromunsatisfactoryexperienceswithcommunityorganisations.

Activity6.9

Createalistofthenegativethingsthatyouhaveheardorseendonethathaveformedbarriersandmadeitmoredifficultforpeopletoaccesscommunityfacilities:

Whenyouhaverunoutofideas,startatthetopofthelistandsuggestpracticalchangesthatthecommunityorganisationmightmake.

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Itissometimesslowandpainstakingworktosupportanindividualtoreconnectwithcommunityrolesandrelationships(Repper&Perkins2003).Itrequirescreativityandpersistence,alongwithcarefullisteningtothepersonspreferencesaboutthesettingandthenatureofthesupporttheyrequire.Awiderangeofapproaches(BatesandDowson2005)canbeused,andthesecanbegroupedunderthefollowingheadings:

Gettingtoknowtheperson.Goodquestionswillhelpstafftofindoutmoreabouthowthepersonthinksoftheirownrecoveryandwhatelementsneedtobeinplacetosupportthatpersonaljourney.Gettingtoknowthecommunity.Agoodlocalknowledgeoftheinformalcommunityisvitalifwearetosupportpeopleandavoidslottingthemintounsuitableactivities.Communitydevelopmentworkers,voluntarysectoragenciesandhealthpromotionspecialistscanhelpwiththistask.

Buildingcapacityinmentalhealthservices.Helpingmentalhealthservicesexpandtheirknowledgeofmainstreamcommunityorganisations,thementalhealthbenefitsofinclusionandawarenessofwhichsupportstrategiesareeffective(SeeESC8MakingaDifference).Thisalsodemandsthereplacementofthepessimisticpredictionsofthepast(e.g.youwillneverworkagain)withrecognitionthatpeopleusingmentalhealthservicescanmakeavaluablecontributiontotheircommunities.

Buildingcapacityincommunityorganisations.Weneedtobuildalliances,delivertraining,dismantlebarriers,andhighlightthebenefitsofreachingthementalhealthconstituency(SEU2004).

Supportforthewholeoflife.Anexampleofthiswouldbemakingsurethatmedicationisnotalteredthesamedaythatthepersonreturnstowork.Family,friends,mentalhealthservicesandcolleaguesincommunitysettingsallneedtoworktogethertohelpthepersontogetandkeeptheirpositiverolesandconnections(SeeESCWorkinginPartnership).

Gettingthereandsettlingin.Assistancewithchoosingtherightsetting,gettingreadytogo,travellingandinduction.

Sustainingparticipation.Thisinvolvessupportingthepersontomoveonfromattendanceintoparticipation.Itisimportantforanyproblemstobedealtwithbeforetheyleadtothebreakdownoftheactivity.Supportneedstobetransferredfromtheformalmentalhealthsystemtothenaturalarrangementsinthecommunitysetting(SeeESC4ChallengingInequalityandESC9PromotingSafetyandPositiveRiskTaking).

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Activity6.0

Thinkofapersonthatyouknowwhocurrentlyspendsmostoftheirlifeinaspecialistmentalhealthsettingbutwhomight,withappropriatesupport,takeupaninclusiveactivity.

Whatarrangementsmightyouputinplacetoaddressthesevenareas(above)?

Ifitisappropriate,arrangetomeetwiththepersonyouhavebeenthinkingabout.Buildaplan,listeninghardforsuggestionsthatcomefromthepersonyouareworkingwith.Usetheworkthatyouhavejustdoneasaresourceratherthanasawaytotakeoverorcontrolthings.Ifyoucantmeetwiththepersontrytomeetwithsomeonewhosupportsthemasupportworker,akeyworkeroracareco-ordinator.

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6.EMPOWERMENT-Unfinishedbusiness

Inclusiondependsonanumberoforganisationalfactors.Considerthefollowingandseeifthereisanyactionthatneedstobetakenwithyourteamorlinemanagertocreateanenvironmentwhereinclusiveopportunitiescanflourish.

Activity6.

Empoweringothersisbestdonebyempoweredpeople.Ifyouarefeelingparticularlypowerlessorpessimistic,thenthisneedsaddressing.Actionneeded:

Aninclusivelifestyleisuniquetotheperson,restingontheirowndefinitionofrecovery,butcreativestaffoftensupportthejourney.Ifstaffareexhausted,thencreativitywillnevercometobirth;whileablameculturewillkillit.Actionneeded:

Inclusiondemandsthatthepoliciesandproceduresofsomeservicesbereviewedandpossiblyredrafted.Inparticular,riskmanagementpoliciesortheirlocalinterpretationscanhavetheeffectofdenyingopportunitiesandreinforcingexclusion(SeeESC9PromotingSafetyandPositiveRiskTaking).Actionneeded:

Finally,workingforinclusiveopportunitiesisusuallyimportantbutrarelyurgent.Thismeansthat,withoutring-fencedtimeandresources,itwillbesqueezedout.Whatprioritydoesthelocalmentalhealthservicereallygivetotheinclusionagenda?Actionneeded:

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NowthatyouhavecompletedthemodulehereareThreeKeyQuestionstoassistyouinfurtherlearning:

Canyousaywhatinclusionmeanstoeachpersonyouworkwith?

Isadetailedinclusionplanpartoftheircare?

Wheredoesinclusionfitintoyourownpersonaldevelopmentplan?

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7.Linkstofurtherlearning

Bates,P&DowsonS(2005)SocialInclusionPlannerIpswich:NationalDevelopmentTeam

Bates,P(ed)(2002)WorkingforInclusionLondon:TheSainsburyCentreforMentalHealth.

Dunn,S(999)Creatingacceptingcommunities:reportoftheMindInquiryintosocialexclusionLondon:Mind.

Repper,J&Perkins,R(2003)SocialInclusionandRecovery:AmodelformentalhealthpracticeLondon:BalliereTindall.

Sayce, L (2000) From Psychiatric Patient to Citizen: overcoming discrimination and socialexclusionBasingstoke:MacMillan.

SocialExclusionUnit(2004)MentalHealthandSocialExclusionLondon:OfficeoftheDeputyPrimeMinister

Websites

TofindoutmoreabouthowEnglishmentalhealthservicesarerespondingtothesocialinclusionagenda,seehttp://www.nimhe.org.uk/priorities/socialinclusion.asp

ToputtheEnglishsituationinthecontextofaninternationalviewpointonmentalhealthandrecovery,seehttp://www.bu.edu/cpr/

Toplacementalhealthworkinaninternationalandhistoricalcontextofthedevelopmentofhumanservices,seehttp://soeweb.syr.edu/thechp/

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