For many years mainstream has been perceived and practised as a key component of the care pathway in mental health provision.
At several stages of the pathway into mainstream there are roadblocks. These can occur from the individual client, from services, even from families and carers. An individual can feel apprehensive of stepping over the threshold into mainstream activities. This can be for a variety of reasons, ranging from self-stigma or from being so long in the mental health system that independence seems a very distant option. Contrary to some current opinion, it is not stigma from mainstream society that creates the main roadblock.
Dr. Pat Deegan's belief is that too often the health system can encourage what she calls 'a career in mental health' and nothing else. This viewpoint is based on her experience as a service user and it still holds true.
A great deal is being achieved by service users themselves to challenge the roadblocks. This is particularly true where creative and personalised use of direct payments and individual budgets have really taken off around the UK. It hasn't happened everywhere but some immensely inspiring stories and testimonials can be viewed at the NMHDU website.
Creative use of direct payments in mental health recovery is currently sporadic. The intention was that this should increase towards full implementation of the personalisation programme. Invididual budgets were scheduled to become the engine for much healthcare practice all over the UK by 2013. However, this is now completely overshadowed and possibly lost permanently, in the thrust towards GP consortia and budget management.
Alongside the sudden disappearance of direct payments is the disappearing access to therapies, both for primary and secondary care patients. Secondary care clients have often lost out in the therapies scenario for a variety of reasons. But clients in primary care are still entitled to a reasonably smooth road to psychological therapies. Entitlement does not ensure that those therapy services are available and in practice these too are disappearing along with personalisation and individual budgets.
Of course any client is free to fund their own mainstream recovery pathway and many do. The outcomes in this area alone (south-west London) have often been formidable. A composer who has funded her own recordings and launches now has self-employment through her music. Many are those who have accessed adult education courses and further training. Individuals have re-accessed faith venues which they had previously felt unable to enter for many years.
Not all these initiatives require direct payments - anyway those have now dried up. Many activities are free to access or funded by individual clients from their own pockets. Where direct payment has been needed it has often made the crucial difference.
Third-sector organisations also do great work in promoting access to mainstream through a variety of initiatives. 'Emergence' is an arts group run by and for service users who are also visual artists. In London and around the country 'Emergence' has pioneered access to visual arts as well as giving a platform for creativity and exhibition spaces for artists with personality disorder.
'Imagine' in south west London and Surrey also promotes a variety of arts opportunities including music production and visual arts. These are open to service users but take place in mainstream settings.
Mainstream environments have their own health, safety and insurance policies. As a consumer, the service user to entitled to the protection of these policies along with every other mainstream customer and client.
