Friday 26 November 2010

Pat Deegan's Common Ground

Pat Deegan's Common Ground is an impressive new initiative in mental health recovery.  Common Ground incorporates goal planning, liaison with GPs and services, person-centred planning and monitoring of medication.  Plus a whole lot more.

Wednesday 17 November 2010

Are UK services ready for direct payments?

Within two years, by 2013, the Personalisation Programme is set to be rolled out across UK health and mental health services.

In June 2010 Eight Primary Care Trusts began roadtesting direct payments for personal health budgets.

'Patients will be offered more choice and control over their healthcare' announced Care Services minister Paul Burstow. 'The launch of the first direct payment scheme is an important step towards putting patients at the heart of everything the NHS does' he added .

The Coalition government has pledged its 'commitment to extend access' to direct payments. As Paul Burstow reasons, direct payments 'is a step away from the rigidity of the Primary Care Trusts deciding what services a patient will receive'.

Quite how the PCTs are going to be less rigid with their budgets is still unclear. Some formidable outcomes have already been achieved in some of the areas where the scheme is being piloted ( testimonial videos on NMHDU website). Nonetheless, the PCTs are still holding the budgets for direct payments.

Where direct payments is not being piloted or simply not understood, patients and carers are still being denied their rights. The 'rigid' approach is still being applied and clients wishing to access mainstream activities of their own choice are being turned down.

The Care Services minister has announced that direct payments 'will stop healthcare from slipping back to the days of one-dimensional, like-it-or-lump-it services'.

It is a great pity and possibly a legal scandal that clients wishing to determine their own recovery journeys are still being turned down by PCTs for direct payments.

'One-dimensional, like-it-or-lump-it services' are still around.

Tuesday 16 November 2010

Do care and support hinder recovery?

Care and support are not the only models or frameworks for mental health recovery. The establishing or re-establishing of what Dr. Pat Deegan refers to as 'valued social roles' can be held back by a mental health system that often encourages the client to choose 'a career in mental health' (Pat Deegan).

A career in mental health means living longterm on benefits and longterm marginalisation from mainstream life. A career in mental health will identify symptoms, diagnoses, medication and team support but will often leave out aspirations, goals, priorities.

Where access to mainstream is encouraged, it can often be through projects or programmes which take place in special settings or are designed for people with mental health conditions. So the marginalisation continues.

A genuine return to mainstream can only take place in mainstream. This is where the role of the bridge builder comes in. A client who has worked with a mainstream bridge builder identifies goals and priorities for him or herself. It is the bridge builder's job to signpost or link the client up with mainstream venues appropriate to the client's life choices. The amount of support a client may request from there on is determined only by the client.

Wednesday 10 November 2010

Equality Act 2010

During the parliamentary stages of the Equality Bill, mental health organisation Mind lobbied with other mental health and disability charities to get a ban on pre-employment questionnaires included in the Act. After securing cross-party support for the principle of a ban on questions that ask about a candidate's medical history and putting considerable pressure on Ministers, the last Government introduced a new clause to the Equality Bill making these questions unlawful.

The Equality Act came into force on October 1st 2010. The act bans companies from finding out whether potential employees are healthy enough to work for them prior to an offer of employment. Candidates will no longer be expected to declare medical issues during the recruitment stage unless it is specifically related to their job role.

Equality campaigners have long argued that employers discriminate against prospective employees with mental health issues, disabilities or a long history of illness, putting people off applying for a job.

However, 65pc of employers still ask a candidate about their health prior to a job offer, and 48pc ask potential employees to fill out a questionnaire detailing medical conditions and sickness records, according to a poll of 100 companies by law firm Pannone.

Jim Lister, head of employment law at Pannone, said: "The penalties for employers include investigation by the Equality and Human Rights Commission and the reversal of the burden of proof, meaning that the employer will be assumed to have discriminated, unless it can show there was another reason for non-selection.

Organisations that learn of a person's health issue after the job offer but fail to make reasonable adjustments and are forced to withdraw the offer face litigation, lawyers have said.

The reversal of the burden of proof is highly significant. Effectively this means that an employee who feels discriminated against on the grounds of mental ill-health, for example, is not required to prove that this is the case. It becomes the employer's responsibility to prove that this is not the case. If proved otherwise, the employer will be required by law to comply with equalities legislation and where necessary, to make reasonable adjustments on behalf of the employee.