Friday 30 September 2011

No symptoms, no problems

“Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems.” Shepherd, Boardman and Slade 2008.

There are implications for any mental health recovery programme if it is to take place regardless of 'ongoing symptoms or problems'. Firstly, it requires that the recovery programme is not determined solely by an individual's clinical diagnosis. Instead, it must be determined by a person identifying what he or she needs to build a life that is 'meaningful and satisfying'.

An appropriate service and environment in which this identification can take place needs to be in place to help signpost the journey towards invidual goals and aspirations. Fortunately, there are strategies built in to the care pathway that can enable individuals to identify personal goals and locate the sites in mainstream where hopes and goals can be realised. Whether these services are commissioned locally and regionally in specific areas is another matter.

It is important that aspirational settings are embedded in mainstream because individual goals are not fulfilled in clinical environments, although they may be identified therein. It is in mainstream where each and every one of us makes the path to achieving our goals. Mainstream is where we live, work, learn, create, exercise, develop and grow. Mainstream venues are the sites where these developments can take place. Sites that include the arts, sports, education, retailing, volunteering, befriending, family, friends, faith and employment. It is broadly one or more of these areas that an individual will identify as useful to his or her developmental choices.

When this person-centred practice is backed up by a team that can help direct an individual to the appropriate mainstream setting, then a recovery programme can start in earnest. It may well be that other settings have helped or continue to help in achieving this - settings such as day services and what used to be referred to as 'sheltered' activities or community projects. The clinical teams also - assertive outreach, O.T.'s and key workers all contribute to client independence.

It is important that the initial conversation about an individual's mainstream goals and aspirations takes place in a mainstream setting. This may well be an individual's first re-introduction to the mainstream world after what could have been years of semi-institutional or supported environments. It is extremely unlikely that the practical hope of achieving mainstream is communicated in a hospital consulting room or even in an individual's own home. Those areas are associated with support, care and treatment. Mainstream recovery has to go beyond these boundaries.

So what sort of team can best support an individual when it's not support he or she is requesting but access to goals and self-development? I would argue that this needs to be provided by a bridge-building team, each member equipped to identify the mainstream venues appropriate to the goals the client has identified.

Regular readers of this blog will know that I am an arts and faith bridge builder based in south London. Readers will also know that I work directly with people referred from secondary care, that is people with what are called 'severe and enduring' mental health diagnoses. I work with colleagues who are all trained in identifying the mainstream areas appropriate to their bridge building roles. The employment advisor must know about mainstream employment, the sports bridge builder about sports venues, the arts bridge builder must know about the arts locally and regionally.

Mainstream is often achieved indirectly and obliquely. For example, a client who has identified music as a mainstream goal may not go on to achieve in that field or may change their mind about music as a choice in their recovery. This can be disappointing for me as arts bridge builder, but it is often the case that these individuals benefit immensely from other aspects of mainstream that the team is able to offer. I frequently find that some clients who have not engaged through the arts are nonetheless following mainstream goals via the befriending service or through volunteering and sports activities.

Conversely, it can be the case that a client who has been signposted to a music outlet in mainstream, goes on to achieve goals that go far beyond the initial contact with a music studio or rehearsal room that he or she has requested. Such clients can and do develop employment and self-employment pathways or go on to further and higher education opportunities. These goals have been achieved through the initial contact with mainstream and couldn't have been realised any other way. Mainstream itself will often generate these opportunities for the client independently of the bridge building service.

Because bridge building has the strength to enable an 'oblique' approach, there can be limitless opportunities for motivated clients choosing their recovery pathway. Even a relapse can only hold up rather than destroy the process. The confidence and skill levels that clients develop in mainstream enhance growth into further mainstream activities and domains.

Imagine Mainstream studio collaboration at Crown Lane Morden

Wednesday 28 September 2011

Mainstream in 2012

The future of the mainstream approach in mental health recovery is bleak.  Once pioneered as the most radical yet realistic approach to the care pathway, mainstream has now been side-lined and pushed into a corner.

The thinking behind mainstream in mental health is simple.  Linking up individuals with mainstream areas of their own choice as part of recovery.  These areas or 'social domains' cover a wide spectrum: the arts, employment, volunteering, sport and healthy living, faith, worship or spirituality, employment, self-employment, education and business.

In 2012, the cuts in mental health provision are deep and across the board.  Employment is touted as a be-all and end-all yet employment often only happens through a gradual re-introduction to mainstream living .  This is especially true for people who are in secondary mental health care with a diagnosis of 'severe and enduring' conditions.

The outcomes that have been attained by individuals who have been referred or self-referred to a mainstream service are often formidable.  Access to mainstream arts providers such as music recording studios, visual arts courses or creative writing workshops have led to individuals succeeding in employment, self-employment, higher education and collaborative enterprises with their peers.

The mainstream approach goes far beyond therapies and this blog contains many examples of its success.

Mainstream is based on recovery as opposed a 'cure'.  It is also based on the individual claiming his or her right to mainstream living along with everyone else.

The opportunity to access mainstream on his or her own terms is not denied to an individual with a 'severe and enduring' mental health diagnosis. Mainstream can be highly supportive of clients' individual aspirations and self-development. Sometimes this encouragement comes directly from the mainstream outlet itself rather than being dictated by carers, statutory services or voluntary agencies. What can be denied and often is, is the opportunity to access the opportunities in the first place.

In many cases, an individual with a 'severe and enduring' mental health diagnosis will only have the chance to access a mainstream activity if it is built in to his or her care pathway and recovery plan.  The professionals who can help signpost people to such activities will be skilled in allowing individuals to identify personal goals and aspirations.  They will also need skills in knowing exactly where the mainstream sites are where an individual can develop and pursue his or her aspirations.   Linking someone up with a mainstream activity of his or her own choice allows that mainstream venue to provide exactly what it is already providing for its clients, users and consumers. 

The client with a mental health diagnosis will be treated no differently from anyone else, unless he or she has specificied particular adjustments.  That too is part of person-centred planning, with individuals free to disclose or not as they deem fit.

There are sound reasons for mainstream being a lot less discriminatory and stigmatizing than it can be portrayed. Mainstream allows individuals to access services as consumers with consumer rights. If someone with a mental health diagnosis freely chooses to develop his or her aspirations in a mainstream environment, there is no good reason why that person should be denied any of the services that particular venue may provide. The client is accessing mainstream as a consumer of that service, not as a 'diagnosis'.

Once a firm relationship with mainstream has been established, there are multiple ways that mainstream finds to continue to develop individual hopes, dreams and aspirations. I have clients who have found employment through accessing music by rehearsing regularly in a mainstream recording studio. Others have opted to join higher and further education outlets to progress with their dream. Yet others have become volunteers in an environment they enjoy. This has not happened because I have requested the venue to provide employment for my clients Far from it - the venue itself often instigates the process or helps provide the signposting. In many cases this can lead an individual towards a working role in the environment where he or she happens to feel most fulfilled.

This is the viral effect of mainstream

Thursday 8 September 2011

John sings original song 'Revival Day' live at London's Jamboree Club

A Career in Mental Health?

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 life coach or 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 not by the life coach.