« Previous | Contents | Next »
Listen
Guiding Principles
This chapter sets out a number of guiding principles for developing a local response to Sections 25-31.
Person-centred and community-centred
Strategies for improvement need to reflect local circumstances. A standardised solution will not be effective, particularly in Scotland where there is a great diversity of communities. Indeed, vibrant communities that engage all their citizens - including those who have, or have had, a mental illness, learning disability or personality disorder - will be unique in their approach to releasing people's gifts and building social and economic capital. Strategies should also be person-centred as 'it makes good business sense to design and deliver better public services which respond to the individual needs of all groups and contribute to effective, efficient and high performing public authorities' 13.
Partnerships
Whilst the duty to promote wellbeing and social development lies with the local authority, this must be conducted in partnership with a wide range of community organisations. By developing opportunities through partnerships with the voluntary sector, local authorities will also be contributing to the Vision for the Voluntary Sector14 and giving recognition to the diverse roles the sector can play and its broad contribution to Scottish life. The types of roles the sector might play include, for example, as a service delivery partner, delivering effective and personalised recovery, social and employment services, and by providing volunteering opportunities to aid positive mental health and wellbeing.
Young people
West Lothian Council pays part of the costs for Penumbra to run a project for young people with drug, alcohol, mental health and self-harm issues who are at high risk of being made homeless.
Local authority staff sit on the project advisory group and can help solve problems that are identified in the work.
Training sessions on self-harm have been provided to the staff teams at a number of housing associations.
Information from Fiona Downie 01506 862 457.
Personal autonomy
People need to control as much of their own lives as possible - Part 1, Section 1, Paragraph (3)(c) of The Mental Health Act emphasises the importance of the patient participating as fully as possible, having the necessary support and information about the range of options available. Increasing autonomy means both the principle of minimum restriction that is enshrined in the Act 15 and a positive duty to offer maximum opportunity.
Work with individuals needs to be driven by that person's unique sense of what makes life worth living, attributes meaning and helps them to develop. Even where the person's preferences are overridden in the interests of safety, they should still be known, valued and acted upon wherever possible, as Part 1, Section 1, Paragraph (3)(c) of The Mental Health Act says that the present and past wishes and feelings of the patient must be taken into account in discharging duties under the Act. This means that arrangements for providing care and support are likely to be individualised, rather than standardised. Individualised support requires a wide array of community-based options that reflect the diverse needs of the whole community - from those who need brief and focused assistance to those who need broad and lifelong support.
As well as increasing autonomy, initiatives for promoting wellbeing and social development need to engage local people from within and beyond mental health services, harness their commitment, values and ideas, and adapt good ideas from other places until they make sense to the specific community 16. Standardised approaches are less likely to work than an individually tailored, community-centred approach.
Supporting inclusive opportunities
A traditional model of service provision has been to group together all the people with a similar diagnosis in a special building or group. Previous investment in mental health and learning disability services has tended to favour such segregated provision and so one of the challenges of taking an inclusive approach is to rebalance investment in favour of individualised support in mainstream community settings.
Taking an inclusive approach means balancing opportunities to move into mainstream community roles, groups and relationships with more traditional opportunities for mutual support among people who have shared a similar experience. Where separate buildings and groups are developed, there should be clear and accessible pathways into more inclusive and community-based settings.
All areas of life
All aspects of a local authority's services go towards enriching lives. Local authorities are not organised in a uniform manner and so it would not be helpful in this guidance to assign tasks to particular departments or job roles. Instead, the areas to consider addressing to meet the duties of the Act include:
- Housing
- Communities
- Employment
- Personal finances
- Parenting
- Statutory education
- Lifelong learning
- Volunteering
- Civic engagement
- Arts and cultural activities
- Healthy living
- Health and social care services
These areas are used in Appendix 2 to assist in structuring the local authority's response to the duties under the Act; there are suggestions for actions for the response. Why should these areas be included? Below, each one is considered for as to why it has an impact on those with a mental disorder and suggestions of actions are given. References to other strategies are also made in order to highlight the cross cutting nature of working towards inclusion.
Housings
People with mental health problems are one and a half times more likely to live in rented housing, twice as likely to say that the state of property repair is poor and four times more likely to say that their health has been made worse by their housing 17. Aspects for discussion and review in this area should include, for example, owner occupation and secure tenancies, access to housing in all neighbourhoods and access to the right level of support to maintain a home, with regard to those who have or have had a mental disorder.
Communities
Evidence from studies of social capital 18 indicates that a healthy local community, supportive relationships and a sense of connection improve wellbeing . Addressing this issue will also assist the local authority in its duties under Building Community Wellbeing19 and establishing its Regeneration Outcome Agreement20.
Areas for discussion might include neighbourhood groups, use of local amenities, participation in associations and interest groups and connections between diverse groups.
Regeneration
In Argyll & Bute, two mental health clubs that used to be run by the Council have been constituted as charities. A development company has also been established as a company limited by guarantee with the aim of stimulating economic development and the formation of new businesses. The Board is made up of service users and representatives from community education, health, social services and the business community.
Contact: Maureen Beaton 01546 604 152.
Working together
Mental health day services, further education and Jobcentre Plus worked together in Angus to create a work preparation course sited at the local college. Lessons have been learnt about how to market such a programme, how to create sustainable relationships between agencies and how to manage the transitions between the roles of service user, student and employee.
Contact: Adrian McLaughlin 01307 475 239.
Employment
People who enter mental health services are at an increased risk of losing their job, their friends and their home, which can lead to further segregation and isolation. Taking an inclusive approach means investing in job retention and other early intervention initiatives to halt the erosion of these roles and relationships. The employment rate in Scotland for people with any kind of learning difficulty lags at least 50% behind the general population, and for people with any kind of mental health problem it is 65% behind 21. In 2006, the Scottish Executive published Workforce Plus: an Employability Framework for Scotland22 and More Choices, More Chances:A Strategy to Reduce the Proportion of Young People not in Education, Employment or Training in Scotland. 23 Both these documents along with Healthy Working lives,24 set out the importance of partnership working in improving employability services and job opportunities. Local authorities can work with other key organisations, notably NHS Boards, Job Centre Plus and Enterprise Networks to ensure that their services work together to promote employment for people with mental disorders. Workforce Plus and More Choices, More Chances both highlighted people with learning disabilities and mental health problems as key groups to whom action should be targeted.
Areas for review should include: employment, vocational guidance, training and self-employment, and their inclusivity and support for those who have or have had a mental disorder.
Personal finances
People with mental health problems are nearly three times as likely to be in debt and may have difficulties obtaining a bank account or financial advice 25. Tackling this issue will contribute to the Closing the Opportunity Gap26 objectives by lifting people permanently out of poverty.
Areas for review should include access to income maintenance, debt management, insurance, credit, banking and purchasing opportunities.
Financial inclusion
Falkirk and Stirling Councils and NHS Forth Valley contribute to funding for Artlink Central. Every three months, an Artlink worker meets with the Councils' Local Area Coordinator.
In 2005, one outcome was a project called 'Bank Notes' that was funded by Clydesdale Bank PLC. The project used drama and music to explore numeracy and banking from the perspective of adults with learning difficulties.
Banner photographs from these events tour bank branches, influencing public perceptions of disability.
Contact:info@artlinkcentral.org
Parenting and statutory education
This is a part of life that brings real wellbeing, self-esteem and social development to both parents and their children when it works well, but can be difficult for people with mental illness, learning disability or personality disorder. Access to education, supportive environments, delivery of education in different formats, and teaching of parenting skills, amongst other positive actions, could all be considered.
Lifelong learning
Lifelong learning continues beyond school days into further, higher and continuing adult education opportunities. A lack of basic literacy and numeracy makes everyday life much more difficult, while learning can improve mental health and employment opportunities. One third of survey respondents with mental health issues identified access to education and training opportunities as a key issue 27. Widening access to educational opportunities will help the local authority to achieve its Lifelong Learning Strategy28.
Areas for review might include transport routes to education establishments, the support needs of staff within the establishment and mental health awareness raising training for all staff in the establishment. For further clarity on the roles and responsibilities of colleges, local authorities and NHS Boards, in making and managing support arrangements for students with additional needs studying at college, see the 2005 Scottish Executive publication Partnership Matters: A Guide to Local Authorities, NHS Boards and Voluntary Organisations on Supporting Students with Additional Needs in Further Education.
Volunteering
Volunteering can help people increase their confidence, self-esteem, sense of purpose and belonging, control over their lives, and links with people who do not have a mental illness, learning disability or personality disorder. Crucially, it can give people the opportunity to be a giver as well as a receiver 29,30. Expanding these opportunities will assist Councils and others in developing a local volunteering strategy. Volunteering can include service giving, mutual aid and campaigning, either formally, such as through an employee scheme, or informally, such as helping a neighbour.
By encouraging and supporting local volunteering strategies, authorities will contribute to their work on meeting the principles of the Scottish Government's Volunteering Strategy.
Volunteering
The City of Edinburgh Council contributes to the funding of the Volunteer Centre and a key staff member from the Department of Health and Social Care provides support and guidance to the centre's strategy group. As a result, every year around 300 people with mental health issues, learning disabilities or other support needs volunteer their time. All agencies that involve volunteers in Edinburgh are working together to create a 'compact' - an agreement identifying good practice in volunteering.
Contact: Jean Cuthbert at the Volunteer Centre 0131 225 0630.
Civic engagement
Civic engagement of all the community improves the quality of decision-making and supports the sense of affiliation and empowerment of individuals and groups 31; it can include political activity and community planning.
Some people may have difficulty participating appropriately at meetings and would benefit from buddying arrangements to facilitate their participation. Others may be eager to take on particular roles, such as chair or treasurer of a group, but may be concerned that a mental health problem could make this difficult; in such instances, a co-chair arrangement could help. For further suggestions see Appendix 2 and Community Scotland's National Standards for Community Engagement32.
Arts and cultural activities
It is widely accepted that arts and cultural activities have a beneficial impact upon wellbeing, participation and self esteem. Initiatives are underway to increase participation opportunities for people with mental illness, learning disability or personality disorder. The opportunity to take part in such activities should not be confined to the therapeutic setting and instead action needs to be taken to ensure that universal services are inclusive of those who have a mental illness, learning disability or personality disorder.
Healthy living
People with mental illnesses, learning disabilities or personality disorders have poorer physical health and a shorter life expectancy compared to the general population 33. Access to primary healthcare is addressed below, but the suggestions for action in Appendix 2 focus on diet, lifestyle and physical exercise. The Scottish Diet Action Plan ( SDAP) 34 is one of the country's best developed and most mature health improvement programmes. It sets out the various steps that individuals and organisations can take to improve diet. The implementation of the SDAP is being supported by a programme of communication and public education.
The health effects of an inactive life are serious. The National Physical Activity Strategy 35 highlights the benefits of physical activity and details a strategy, including recommendations, to increase the level of physical activity across the population.
Open to all
A Healthy Living Centre in Moray is open to the whole community and promotes good health through exercise, sharing health information and a range of other activities. People concerned about their mental health can self refer, utilise a range of complementary therapies and request membership of the 'exercise on referral' scheme. This means that people have improved access to a range of ways to address mental illness and promote mental health. Contact: Margaret Christie 01343 567 356.
Sports
A physiotherapist who works in mental health services in Midlothian encourages people to exercise and supports them to take up mainstream leisure classes. Leisure centres offer free admission to people referred by health staff, and to a supporter chosen by the person. The local Mental Health Forum oversees the project and includes representatives from education, employment and the voluntary sector.
Contact: Michael Skelly 0131 536 7681.
Health and social care services
These services have a role in supporting all the above opportunities, by working with universal services and individuals to promote rather than hinder opportunities.
Formal roles and informal relationships
It is important to promote opportunities for people to become employees, informal carers, students, neighbours and sports players. However, action to promote inclusion must also respect and nurture the less visible connections and activities that represent the social capital of communities and neighbourhoods. Finding and holding the delicate balance of opportunity without coercion will pay dividends. Friendship-friendly workplaces can be more productive, colleges and leisure activities that give people time to get to know each other have lower drop-out rates and neighbourhoods where people keep an eye on each other's homes have less crime.
Managing risk
Ayrshire and Renfrewshire pay Partners for Inclusion to support individuals.Partners tailor-makes the support for each person using Person-Centred Planning. This often involves specific arrangements to support people's friendships, as well as practical things like securing a home and finding things to do.
One person needed detailed help to enable him to reduce fire setting and self-harm. The Housing Department fitted a sprinkler system to his flat and Partners was closely involved, along with the GP and emergency services. Partners reject nobody and have stayed in touch during the tenant's prison term, ready to support again on discharge.
Contact: Doreen Kelly 01563 825 5555.
Many partners, many layers
There is a complex web of interaction between different formal and informal agencies in the community. This highlights the need for local authorities to adopt a multi-layered approach with a wide variety of partner organisations. The work that leads to increased opportunities needs to be done with individuals, within and between organisations and at a strategic level, including partnerships with the voluntary sector 36.
Challenges
The challenges that accompany such an inclusive, interactive approach include an increased need for communication, such as through the Community Planning process; co-ordination, perhaps with an Action Plan; and progress monitoring, by embedding targets into current performance management frameworks. There should also be arrangements in place for identifying and resolving conflicts and difficulties that will inevitably arise as different agencies increasingly work together.
Conclusion
These principles - to be person-centred and community-centred, to support inclusive opportunities, to reach all areas of life, to pay attention to both formal and informal relationships and adopt a multi-layered, mainstreaming approach - form the common threads of a response to Sections 25-31 of the Mental Health Act.
« Previous | Contents | Next »