SWUF A Mental Health Service User Group

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SWUF A Mental Health Service User Group

• Presented by Michelle Evans, Theresa Jones,
  Holly Potter, Selina Rawicz, Josh Sklar, Bethan
  Smith and Rachael Turner.

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• Mental illness is very common. About one in
  four people has this diagnosis, but there is a
  great deal of controversy about what it is, what
  causes it, and how people can be helped to
  recover. People with a mental illness can
  experience problems in the way that they think,
  feel or behave. This can significantly affect
  their relationships, their work, and their
  quality of life. Having a mental illness is
  difficult, not only for the person concerned, but
  also for their family and friends. Mental
  illnesses are some of the least understood
  conditions in society. Because of this, many
  people face prejudice and discrimination in their
  everyday lives. However, unlike the images often
  found in books, on television and in films, most
  people can lead productive and fulfilling lives
  with appropriate treatment and support. For some
  people, drugs and other medical treatments are
  helpful, but for others they are not. Medical
  treatment may only be a part of what helps
  recovery, and not necessarily the main part. It
  is important to remember that having a mental
  illness is not someone's fault, it is not a sign
  of weakness, and is not something to be ashamed
  of. Seeing someones problem solely as an
  illness that requires medical treatment is far
  too narrow a view. It discourages people from
  thinking about the many different influences on
  someone's life, on their thoughts, feelings and
  behaviour, which can cause mental distress. It
  may also prevent people from exploring the
  various non-medical treatment options that are
  available. For these reasons, some people prefer
  to talk about mental or emotional distress,
  rather than mental illness MIND Website

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Overview

• Introductions
• The Medical and Social Model
• Labels/ Stigma
• Back to the future?
• Paws for thought

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Introductions

• Why the mental health user group?
• Personal and professional interests
• A short exercise
• Why is SWUF different from the other service user
  groups?
• Power and autonomy

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• Ideas of normality Goffman and social
  interactions
• An example
• Visibility and the disabled peoples movement.

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Introduction cont

• Introductions to SWUF
• The importance of a voice

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• Who attended?
• Lots of diversity (?!)
• Terms used
• Service User
• Mental illness
• What was decided in regards to these terms and
  why?

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• Exercise and the term brainstorming
• Why this was positive, implications for the
  service user and us as social workers.

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Mental Health/illness

• Not Illness prefers the terms disorder/
  emotional distress/ emotional dysfunction/ mental
  disability
• Schizophrenia/ Bi-Polar/ Neurotic/ Psychotic/ OCD
• Survivors/ just getting by as opposed to
  living
• Repression/ stigma/ social exclusion, i.e
  employment jury service/ marginalized/ stressful
  scenarios/ enclosure

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Mental Health/IllnessContinued

• Lack of concentration
• Labelling
• Media negative/ violence/ fear/ psychopath/
  mad/ wrong impression/ wrong perception
• Action groups set up to counteract effects of
  media/ MIND
• Education required in order to change attitudes

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Social Work

• Busy bodies/ nosy parkers/ separating families/
  needy people (service users)/ friction (-)
• Reactive (-)/ radical activists (/-)
• Practical help/ supportive/ friendly/ regular
  contact/ compassionate/ caring/ empathetic/
  befriender/ human/ mutual respect /role model/
  genuine/ advocate ()
• Going beyond the call of duty/ parameters set ()

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How People Treat You

• Employment discrimination against/ catch 22
  tell them about your illness no job or not tell
  them and risk being found out, then sacked for
  lying
• Need to prove yourself even before being given a
  chance
• Form filling
• Shabby/shoddy treatment oppression

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How People Treat YouContinued

• Labelling can be due to type of medication
• Medical model rather than holistic approach
• Distorted in the media/ film people feel like
  they know you and your problems as a result
• Made a joke out of/ stigma ignored by
  psychiatrists

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How You Would Like to Be Treated

• With empathy/ respect/ equality/ compassion/
  care/ professionalism/ as an individual
• Being given opportunities, e.g MIND/ empowered/
  heard by appropriate people/ accepted socially
• Have suitable housing/ accessible transport
• Live in a therapeutic environment

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Medical and Social perspectives in Mental Health

• Looking at Service Users experience of medical
  and social intervention
• By talking to Service Users in group and as
  individuals in one to one meetings
• Highlighting group and individual perceptions of
  their care/treatment programmes
• Relating their experience to medical and social
  models of caring for people with mental health
  problems

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Medical and Social perspectives in Mental Health
(Service users perceptions of medical
intervention)

• Emphasis on medical treatment (medication, ECT)
• Not happy with Side effect of medication
• Power of diagnosis (labelling)
• Understanding of the diagnosis
• Coming to terms with diagnosis and coping with
  stigma

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Medical and Social perspectives in Mental Health
(Service users perceptions of Social intervention)

• Social Workers are busy bodies, nosey parkers and
  they separate families
• Not much understanding of Social Workers role
• Not as easy to get help from a Social Worker as
  it is from Health Professionals
• Those with Social Workers have a better
  perception of what they do and are more positive
  about the help they receive

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Medical and Social perspectives in Mental Health
(medical model)

• Long history, Early days of incarceration and
  separation from society with little in the way of
  treatment, latter on ECT and surgery
• More recently based with biological intervention
  of treating the symptoms with drugs (and
  sometimes ECT) with a view to stabilising their
  condition and moving them back into the community
• Still involuntary admission and treatment orders
  under the Mental Health Act (1983)
• Medical model still dominant

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Medical and Social perspectives in Mental Health
(social model)

• The focus is on understanding mental illness
  within the social context of individuals
• Sees interpersonal relationships as explanations
  of behaviour rather than isolate the individual
  from family and environment
• Looks for explanations for psychiatric breakdown
• Working with the person and educating them and
  their families to help them live within society
• Offers an alternative to the purely medical model

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Medical and Social perspectives in Mental Health
(Social and medical intervention and support)

• Health and Social Services work in partnership
  with each working from their own theoretical base
• Medical staff from the nurse to the psychiatrist
  treat mental illness in the same way as physical
  illness
• Diagnosis, psychotropic medication, TLC,
  monitoring recovery
• Behavioural/cognitive therapy from psychologist
  and Occupational Therapy to improve deficits in
  personal, social and economic functioning

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Medical and Social perspectives in Mental Health
(Social and medical intervention and support)

• Social Workers meet with families as well as the
  person giving a social biography to help in
  diagnosis
• Are a link between the hospital and
  friends/relatives helping them cope
• Co-ordinate the provision of care including
  health, housing, income, occupation and social
  inclusion
• Educate about diagnosis, prognosis and treatment
  including coping with side effects of drugs
• Planning care around changing needs

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Medical and Social perspectives in Mental Health
(Social and medical intervention and support)

• Improved treatment of people suffering from
  mental illness over the years
• New partnerships provide continuity of care
• Gradual education of others in society to
  alleviate labelling and stigma
• Society still will not tolerate the behaviour
  which is sometimes displayed by people suffering
  from mental illness

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Exercise

• M is a 36 year old woman who has had experienced
  a long period of domestic violence spanning some
  20 years. After fleeing her family home she took
  refuge in a womens shelter in another city.
  Staff at the shelter became increasingly worried
  about her erratic behaviour and the unruliness of
  her two children. Social Services were informed
  and the children were placed into voluntary
  foster care. M was diagnosed as bi-polar (manic
  depression). Six months on and M is feeling
  better, but continues to live in the shelter, and
  her children are still in foster care.
• How can we help M to get her life back on track?
• Consider what obstacles M may encounter in this
  process.

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Mental Health

• Media and Stigmatisation

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What SWUF said
about the media
To what extent is the media responsible for
negative perceptions and the stigmatisation of
mental illness?
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What the literature says

• Those with Mental Illness in the media are
• Considered a danger to themselves
• Considered childlike unable to care for
  themselves
• Portrayed as different and terms used include
  psychotic and unstable
• Depicted as
• Dangerous and unpredictable
• Unsociable
• Unemployed
• Transient
• Sensational, vivid stereotypical language is
  used

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What the research says

• Signorielli (1989) 72 of characters on USA TV
  with MI were depicted as violent compared to 42
  of normal characters
• Rose (1998) two thirds of people with MI were
  portrayed as violent in British TV news stories
• Wahl (2000) with reference to 107 magazines
  depicting Obsessive Compulsive Disorder over 15
  years, only one third portrayed the condition
  accurately

Negative and unbalanced media coverage
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The consequences
STIGMATISATION!!!

• Wahl (1999) Stigmatisation is detrimental to
  the well-being of persons with mental illness
  discrimination
• 1300 people questioned reported stigmatisation
  left them discouraged, hurt, angry and lowered
  their self-esteem
• Others treated them as less competent
• MIND questioned 515 people suffering from MI
• 73 said coverage unfair, unbalanced or very
  negative
• 50 said coverage had negative effect on their
  mental health
• 25 said neighbours behaved in hostile manner due
  to media

Poor, unbalanced press coverage of mental health
issues fuels stigma and reduces quality of life
for sufferers (MIND)
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Wot the Sun said

• What MH groups said
• Belongs to an era when Mental patients were
  locked up like animals
• Ignorant reporting
• Insult to Bruno thousands of people who endure
  MI
• Reporting reflected prejudice against mental
  illness throughout society Dr Liam Fox

MIND SANE called for a more mature, sensitive
understanding approach to mental illness
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Power WITH responsibility

• Service User group identified a need for more
  positive, informative and educational media
  coverage
• Important because, lacking direct experience,
  media is opinion-former
• Media DOES have power to inform, educate and
  raise awareness
• Cathy Come Home
• Amnesty International
• More SUs working with media than ever before
• Debate and discussion is helpful

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A positive way forward
The Changing Minds campaign was launched to
inform the media and public, and tackle stigma
(changingminds.co.uk)
A London Underground poster
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FILM GOES HERE
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Changing Minds Campaign
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(No Transcript)
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Access to Employment for people with
Mental Health problems.
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I hope we all agree that .

• It is extremely unjust, a waste of human
  potential, a great cost to society, and unlawful
  to exclude anyone from employment simply because
  that person had experienced or experiences mental
  health problems.
• http//www.dh.gov.uk/assetRoot/04/06/03/81/0406038
  1.pdf

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However

• discrimination in the workplace is one of the
  greatest barriers to social inclusion.
• Unemployment affects those with long- term mental
  health problems more than any other groups of
  people with disabilities (ONS 1998).
• Only 13 are in employment compared to over a
  third of people with disabilities generally.
  (Labour Force Survey 1997/98)

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Experience of Service Users as expressed
throughout consultation

• At least four of the service users felt that
  their mental health problems affected access to
  employment.
• At least two clients felt that they had been
  actively discriminated against in their
  workplace.
• There were occasions when clients were turned
  down for internal jobs they applied for. It was
  later discovered that the rejection was due to
  concerns of previous hospitalisation of the
  applicant.

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• One client stated that when they were first ill,
  they wanted to work but
• The psychiatrist told them to take a couple of
  years off and to treat it like a holiday. The
  client has done so ever since.
• The client had got used to psychiatrists making
  lots of decisions for them and expects
  psychiatrists to make decisions for them about
  going back to work.
• The client would like the government to push
  them back to work so that they at least know if
  they will be able to deal with it.

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• At least one client felt that if they were to
  start working again, they could take or need less
  medication.
• However, it was also stated that the medication
  drains away the incentive to work and they would
  be more motivated if they were on less
  medication.
• One client cited an occasion when their Community
  Psychiatric Nurse came to their workplace to give
  them an injection and their employer found out
  that they suffer from mental health problems and
  consequently moved then to an easier job.

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• One participant had raised the issue of the
  Disability Working Allowance to a prospective
  employer. He was not successful in getting the
  job and thought this might be because he was
  discriminated against.
• One service user stated that most survivors who
  are in paid employment work in the mental health
  field.

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Access to Education

• At least one service user felt they had been
  discriminated against at a local college when the
  tutor on a computer course thought they were just
  lazy and that their mental health illness was an
  excuse and this has put them off education
• Whereas at least one other participant attended
  a very supportive college and was the source of
  much of their social life.

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The strategies used to cope with discrimination
in access to employment

• Not declaring that they had been previously
  hospitalised due to mental health problems or
  that they had a mental health problem at all.
• At least one client described a Catch 22
  equation regarding employment,
• Tell them (potential employer) about your
  illness means no job or not tell then and risk
  being found out, than sacked for lying

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• One service user did not tell their employer of
  their medical health problem and tried to keep
  this concealed. This led to increased paranoia
  and stress which induced schizophrenic symptoms .
• Ultimately they had to stop going to work. The
  service user stated that they would avoid this in
  the future and would like to find a job with an
  employer who is sensitive to those suffering from
  mental health problems.
• The service user would like to get a job as a
  support worker with people with mental health
  problems but is waiting for a time when they feel
  more prepared and able.

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Disability Discrimination Act 1995

• The employment provisions of the Disability
  Discrimination Act came into force Dec 1996
• Under the Act , it is unlawful for most employers
  to treat a disabled person less favourably then
  someone else because of his or her disability
  without justification, or fail to comply with a
  duty upon them to make reasonable adjustments
  without showing that the failure is justified.

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• One of the definitions of disability the Act
  works with is that a disabled person is someone
  who at the relevant time has a physical or mental
  impairment.
• The Act does not include any impairment resulting
  from or consisting of a mental illness unless it
  is a clinically well- recognised illness.
• Examples of conditions include depression,
  schizophrenia, dyslexia, bi- polar (manic
  depression) and learning disabilities.

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Moving forward

• It is suggested that what is needed is for all
  employers, not just the public sector, to commit
  to anti- discriminatory principles.
• http//www.dh.gov.uk/assetRoot/04/06/03/81/040603
  81.pdf
• It must include the commitment that this type of
  discrimination is taken seriously and will be
  eradicated.
• Mental health should not be the cause of derision
  or ridicule and people with mental health
  problems have the same right to be treated fairly
  and with respect as everyone else.

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• Some of the main issues identified are tackling
  discriminatory attitudes within the workplace and
  issues of confidentiality.
• http//www.dh.gov.uk/assetRoot/04/06/03/81/040603
  81.pdf

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Employer Case Study

• The NHS are described as taking a lead role in
  anti- discriminatory access to employment for
  people with mental health problems incorporated
  in, Mental Health Issues in Employment.
• This guidance aims to address the management of
  mental health issues in employment, raising
  awareness among staff and reasons for employing
  people with mental health problems.

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Reasons for Employing People with Mental Health
Problems

• reasons cited for employing people with mental
  health problems was based on the skills and
  experience gained throughout the course of their
  illness and how these skills could be used to
  improve the quality of the mental health services
  offered.
• These are valid claims and it is often the case
  that those suffering or who have suffered with
  mental health problems go onto roles where they
  can support others with mental health problems.

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However

• it can argued, that this is not anti-
  discriminatory or inclusive. Is it enough to say
  these people are useful in the mental health
  arena only?
• Reasons to employ people should not be based on
  their experiences as a sufferer of mental health
  problems alone but on individual ability and
  rights to employment.

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The Role of Social Work in Mental Health

• Mental Health Act 1983 introduced the Approved
  Social Worker (ASW) role
• By the end of the 1980s, Community Mental Health
  Teams were set up these brought social workers
  and mental health professionals under one roof.
• Proposal to replace the ASW post with an Approved
  Mental Health Professional (AMHP), this post will
  straddle both health and social care

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The Way Forward

• The Department of Health policy guidelines 1999 -
  those people who use mental health services
  should be involved in the planning and delivery
  of care that they receive.
• Service user involvement can take a number of
  forms,
• as a recipient of communication subject of
  consultation and agent in control, with levels of
  interaction between fellow service users, between
  user and professionals, management of local
  services and planning of overall services. (Peck
  et al (2002))
• Hickey (1998) identified a participation
  continuum which included information/explanation,
  consultation, partnership and user-control.

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The Way Forward continued ..

• Service user involvement is imperative as
• Bracken Thomas (2001) Double (2002), and Smail
  (1993) all recognised that our current
  understanding of psychological distress is
  partial and limited.
• With the introduction of the Mental Capacity Act
  2005, it is felt that the needs of the service
  user will be better met.
• Harper (2002) advocated moving away from the
  tyranny of expert knowledge.
• Beresford (2000) felt that the inclusion of
  service user groups in training was imperative
  for the future of social work.

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Back to the Future

• Mental Health - implications for the 21st
  century

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The Mental Health Bill

• Defines when and how individuals diagnosed
  with a mental health illness can and should be
  treated without their consent.
• Treatment without consent should only be
  administered if absolutely necessary.
• Treatment should be explained to the patient.

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Mental Health Bill cont

• Mental Health Advocacy Service to be set up under
  the terms of the Bill.
• Allows for Service Users to choose a nominated
  person to vouch for them.
• This does not need to be a health professional.
• Social Worker role is limited and sparsely
  referred to.

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What the critics say

• Emphasis within the Bill is on the avoidance of
  risk rather than providing benefit through
  appropriate treatment interventions. (S. London
  Maudsley NHS Trust)
• Mental Disorder and Medical Treatment
  definitions too broad. (S. London Maudsley NHS
  Trust)
• Mental Health User groups agree.
• a public order Bill dressed up as mental health
  legislation.

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What the critics say cont

• Mental Disorder and Dangerousness reinforcing
  the stigma.
• It risks substantially increasing the
  stigmatisation of a vulnerable group, contrary to
  the entire thrust of current mental health and
  social care policy (South London Maudsley
  NHS Trust)

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Social Workers and the Mental Health Bill

• No power to singularly veto the use of
  compulsion.
• Constrains the independence of the Approved
  Social Worker role.
• Approved Mental Health professionals might
  replace Approved Social Workers.

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Employment and Mental Health

• Less than 4 out of 10 employers would knowingly
  employ an individual with a mental health
  condition. (The Social Exclusion Report 2004)
• People who experienced mental distress have the
  highest rate of unemployment amongst people with
  disabilities.
• Only 19 are employed.

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Progress?

• Very little increase in the past 10 years in
  adults with neurotic or psychotic disorders in
  the labour force. (Mental Health and Soc.
  Exclusion Report)
• Over half of respondents in a survey commissioned
  by the Office for National Statistics believed
  they had definitely or possibly been turned down
  for a job due to their mental health problems.
• Most did not feel confident disclosing their
  experience of mental health problems on job
  application forms.

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Some good news

• Mental Health and Social Exclusion Project
  outlines Govt. commitment to-
• Reduce social exclusion among adults with mental
  health problems.
• Prevent these individuals from falling out of
  the labour market.
• To ensure they enjoy and have access to the same
  opportunities for social participation and
  access to services as the general population.
• Working with Service user groups.

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Thank you for listening!!