Image: Phil Hamer
This government has promised that mental health will at last be given ‘parity of esteem’ with physical health.
We need it. We have a psychiatric system still rooted in nineteenth century notions of medicine and ‘science’. Successive governments have failed to drag it into the twenty first century. Psychiatric policy is underpinned by a narrow medical model which service users report is damaging, unhelpful and stigmatising. It is far too reliant on drug treatments which are repeatedly shown to be of limited effectiveness, have problematic ‘side’ effects and give an undue influence and responsibility to ‘big pharma’.
But what is mental health actually getting from government?
Not any new funds - mental health continues to be grossly underfunded.
The latest funding changes have imposed a 20% higher cut on payments to mental health services, than to acute hospitals. Mental health patients are being discharged into B&Bs to free up mental health beds, it was reported this week. And three quarters of local NHS Clinical Commissioning Groups have just announced cuts to already overstretched mental health funds for young people.
In recent years only forensic and compulsory ‘treatment’ have had funding increases - and even this now appears to have been reversed.
Nor does ‘parity of esteem’ seem to mean more ‘person-centred’ care.
Service users call for person-centred support, flexibility and non-medicalised services. They call for user-led out of hours, crisis and peer support provision.
But both councils and the NHS are instead cutting day care, social work, occupational therapy and other valued help. Posts remain unfilled, increasing caseloads for mental health staff.
In fact, the only way in which the Coalition is being even-handed with mental health is in its commitment to privatisation - as strong with mental health as with the rest of the NHS.
Psychiatric services are being outsourced at an accelerating rate. Capita, Virgin Care, Accenture, Reed, G4S and Serco are lining up for lucrative contracts despite a minimal track record in this difficult area. The growing presence of big private sector providers is diverting scarce NHS resources away from frontline support and into corporate profits.
The increasingly privatised services emphasise ‘throughput’ – people receiving short care help rather than long term support. Short term provision and drug interventions are prioritised over longer term talking treatments and the kind of family and social support valued by service users and carers. New managerialist techniques ignore calls from service users and instead talk of ‘care pathways’ and ‘payment by results’ (PbR).
Support is seen as only needed temporarily, until ‘normality’ is restored - ignoring the reality of many people’s situation. Mental health conditions often fluctuate, and people need ongoing help and support to maintain progress.
At the heart of new developments in mental health lies the bright, new, cosy-sounding idea of ‘recovery’. This has been welcomed by some service users. It suggests they will no longer be written off as ‘hopeless cases’, doomed to be damaged – and perhaps damaging - for the rest of their lives. Instead they are offered hope that their problems can be helpfully addressed and they can ‘get their life back’.
But increasingly service users find the officials dealing with them, under pressure from above, are using ‘recovery’ and related terms like ‘reablement’ to mean simply getting people off benefits and into employment – any kind of employment.
As the high profile Campaign to Save Mental Health Services in Norfolk and Suffolk points out, the impact of all of this is devastating.
People in crisis are waiting up to eight hours for an ambulance. Because of cuts in local beds, mental health service users are being sent all over the country, sometimes to costly private hospitals. People are not receiving their personal budgets, a flagship government policy, because of cuts in services. Patients who had remained well with outreach services are now coming back in need of help because these have been cut back.
As local MP and Care Minister Norman Lamb was launching a ‘Mental Health Crisis Care Concordat’ the campaign was highlighting that over a period of five months in 2013, there were 22 unexpected deaths among mental health service users.
It is because of this enduring crisis in mental health services, that the Social Work Action Network (SWAN) has launched its Charter for Mental Health this month at its international conference in Durham.
As the Charter highlights:
The support on which many service users rely is being brutally cut as a result of the government’s austerity policies. This includes closure or reductions in the availability of community services alongside increased charges, time limited support and reduced funding for user-led organisations.
Meanwhile the government’s welfare ‘reform’ programme is creating poverty through draconian measures such as the Work Capability Assessment, implemented by private healthcare firm ATOS, and the Bedroom Tax. These policies are having catastrophic effects. Service users’ networks of support are being damaged, and levels of stress are escalating. The result is increased anxiety and fear and a rising incidence of suicide and self-harm.
SWAN is a major independent grouping of progressive social work educators, practitioners, service users, carers and researchers. Its new Charter describes the impact of cuts, privatisation and welfare reform on mental health service users, their families and workers. It calls for us to build alliances of resistance to develop more and better support for those with mental health needs.
There have been recent victories we can learn from. In Salford, service users supported by trade unionists mobilised against mental health cuts under the United Service User Committee banner. Their inspiring campaign not only successfully stopped the closure of their drop in centres, but ensured service users were more democratically and collaboratively involved in how the service was run.
SWAN's Charter has emerged through discussion with service users and mental health practitioners. It does not aim to be a definitive statement, but rather a starting point for discussion and action and a helpful campaigning tool for activists. The aim is to bring people together to secure the values and principles that have long underpinned the best community based mental health practice but which are now increasingly under threat. To engage everyone involved in mental health service provision, from traditional charities and new ‘user led’ organisations, to social enterprises, supportive independent organisations and more traditional statutory agencies, as well as the ‘micro employers’ who make up of the growing numbers of service users accessing direct payments and personal budgets.
The Charter calls for:
More user-led support and social approaches
More effective challenging of discrimination
Overcoming obstacles to participation
More and better support
It emphasises alliances, joint campaigns and co-production between service users, trade unionists and others.
Finally the Charter sets out a series of demands. Taken together these provide a rallying cry for sustainable person-centred mental health policy and practice.
Already conferences/workshops based on or including the Charter are planned in Liverpool, Bristol and Oxford and SWAN hopes that others will be able to follow this lead. Please contact SWAN if you would like to endorse the Charter either as an individual, service user/carer group, trade union, campaigning group or other organisation and/or if you would to organise joint meetings, events or actions.