MANCHESTER PREPARES FOR A CHARTER FOR MENTAL HEALTH PATIENTS
“As a direct result of ‘Patient’ (Services Users) receiving some of the poorest commissioned mental health care in the country , Manchester services user groups have been working with MACC and other mental health support groups on a Manchester Mental Health Charter; which already holds the support of Manchester Services User groups and carer groups and is presently seeking pursuant to further consultation with ‘Services Users’ and the Manchester People and which will eventually give legally binding protections from discrimination because of mental disability and should contractually enlist all members of staff who work for the three Manchester commissioning Groups who commission for Manchester mental health services for patients within their remit.”
Statement Made By MUN Chair To North Manchester CCG
Below we have published three recent examples of what patients, users of mental health services (services users) in Manchester have been saying they now want in a charter for mental health. Please leave in the comments section below what you would wish to see in a Manchester charter . The three Manchester Clinical Commissioning Groups (CCGs) are listening so please add your voice and be heard “It’s Time to Be Heard”
Charter for mental health
The charter is necessary:-
To increase understanding about mental health conditions To expose stigma and discrimination, its impact on people who have experienced a mental health condition and to challenge negative stereotypes. To expose the links between poverty, inequality and mental distress. To inform the public, service users and carers about evidence based services, therapies and interventions which should be available for people with mental health conditions To demand a set of standards and guaranteed treatments from mental health services for people with mental health conditions To stop cuts to already inadequate services To develop a set of demands with service user and other campaigning organisations To assist in the organisation of service users family and friends of users and members of other groups against cuts and austerity and around demands for a humane and effective mental health service
What is mental ill health?
Mental health conditions describe symptoms of human distress. Symptoms of distress are experienced by all human beings at some point but are usually labelled as illness when they cause more serious problems. Causes are multiple and can be physical, genetic or social. Symptoms include depression, anxiety, and negative self-beliefs information processing difficulties like delusional beliefs or hallucinations. These can lead to destructive behaviours like suicide self-harm drug and alcohol use and negative relationships with others Stigma associated with mental health conditions and the side effects of medical treatment causes social and psychological damage to the individual which is at least as bad as the condition.
Most people with mental health conditions are at least as skilled, intelligent and creative as the overall population. The stigma associated with these conditions however, is endemic in society. Stigma and discrimination associated with mental health is still widespread and institutional. People are denied access to employment education and services. Abuse within institutions is extensive. In the UK today people with mental health conditions are often held in police custody inappropriately People are detained in psychiatric hospitals in poor environments without privacy or adequate personal space and denied access to basic facilities. Generally in society people especially with more stigmatised conditions such as schizophrenia are discriminated against and individuals fear discrimination As a result they often become isolated and are denied human rights of employment education access to health care and human relationships. The treatment of people diagnosed with mental health conditions is associated with racism. African and Caribbean men for example are still 3 times more likely to be viewed as potentially violent and detained under the mental health act or restrained when in services. Mental health services were officially described as institutionally racist after an inquiry into the murder of Rocky Bennet in 1998 during physical restraint by staff on a mental health ward Much is known about interventions and experiences which can help people to regain their lives. Treatments which people receive however are often unsafe. Ignorance and fear mean the government can continue to provide second rate services which are the first to be cut.
While some mental health conditions are neurological in origin, these can be directly caused or exacerbated by social deprivation Some obvious sources of distress are poverty, unemployment, trauma including the effects of war, sexual and emotional abuse, stigma and discrimination of groups of people, isolation. Mental health conditions, depression and suicide have increased since the onset of the recession. Stigma and discrimination affects people directly denying access to jobs, services and relationships. The indirect impact of stigma is that people isolate themselves due to loss of identity and esteem and an expectation of rejection by others. Any society should provide secure housing, mental and physical health care, education, satisfying decently paid employment, access to child care and transport within a safe, supportive environment for all its citizens The right to mental health services which are evidence based and safe Mental health services have always been under resourced, lacking in evidence and often treatments are unsafe. A service which ensures evidence based therapy aimed at the restoration of a satisfying lifestyle for individuals is needed. Drugs used to treat mental health conditions often have damaging side effects. While they are sometimes necessary to control distressing symptoms they should be used in minimum doses and reviewed. Research must be increased with the aim of complete safety. Drugs should not be the only treatment. Occupational vocational assessments and therapy and social support to establish a healthy satisfying lifestyle again should be guaranteed when employment, education and social networks have been damaged or lost. Anxiety and symptom management through non invasive alternative therapies such as aromatherapy yoga meditation should be an essential part of all treatment Research into nutrition, exercise and mental wellbeing should be used to provide individual advice and support to maximise mental health. A range of psychological therapies and counselling should be provided as a right. Occasionally symptoms cause high levels of distress and sometimes risk. In these cases accommodation should be available in therapeutic, comfortable environments with access to non-invasive evidence based treatments, alternative therapy, drug rehab, lifestyle planning and psychological therapies.
Extensive research into ‘psychiatric’ drugs alongside nutritional science and non damaging non intrusive treatments Occupational vocational assessments/therapy and social support to ensure people to establish a healthy satisfying lifestyle Access to safe non invasive alternative therapies to reduce anxiety and the need for damaging drugs Guaranteed access to a range of psychological therapies and counselling Access to accommodation when necessary in a therapeutic and humane environment No enforced cuts in facilities or services for people who have experienced mental distress. Individual advocacy and support to ensure rights to accommodation, education and paid employment are met. A full and thorough public investigation into stigma and discrimination in every service and institution and legal action to ensure its elimination.
Greater Manchester Keep Our NHS Public (KONP) Charter :-
Charter for Mental Health Services in Manchester
Introduction This charter is about what people want from mental health services in Manchester. It has been drawn up from what people who use mental health services have said in consultations over the last few years.
On the following pages these wishes have then been explained in more detail and translated into the language of commissioning. Each wish has been translated into an outcome and an overarching aim for a mental health service. Accompanying each outcome is a set of suggestions for monitoring whether the outcome has been achieved.
A service user is defined, for the purpose of this charter as “someone who has direct personal experience of mental distress”. This may or may not mean a current user or previous user of voluntary or statutory mental health services. (Adapted from Dorset Mind Service User Policy).
A person is a “user” of any health services if the person is someone to whom those services are being or may be provided. (Department of Health 2007).
Who developed this CharterThis charter was drafted by a steering group, co-ordinated by Macc and made up of people who use mental health services and people who are active campaigners for improvements in mental health services. The job of the steering group is to promote the Charter and monitor its usage and impact.
How can you get involved? • Tell us know how you will use the Charter For instance you may use the Charter to guide the development of your services or use it to campaign for change in other organisations.
• Propose additions Please note this charter is based on what people who use services have already said so we do not want to take anything out. Also we think it is more powerful in its current form by being short and using simple straight forward language. If you think that something important is missing please email John Butler, email@example.com with your proposed additions. Any proposed additions will be discussed and agreed by the steering group.
• Attend Charter Alliance meetings At our first Charter Alliance meeting we will discuss the Charter, agree a plan of action and how we will implement, monitor and evaluate the Charter. We anticipate, following further discussion and consultation that the wording of the outcomes and the ideas for monitoring the charter could be improved or may look different for different organisations.
If you wish to attend this event please contact John Butler at Macc with your contact details, email: firstname.lastname@example.org
This report was prepared by John Butler from Macc, 28 April 2014
Charter for Mental Health Services in Manchester
- We want to feel that we’ve been listened to
- We want to have a real influence on services
- We want to be part of services
- We want to be part of our own care
- We want services to decrease stigma
- We want services to think properly about the consequences of changing what they provide
- We want services that work for people from all the different communities and cultures in Manchester
- We want services to understand us as whole people
- We want to know what services are available
- We want to know what’s happening in services
The Charter in more detail Click on each of the wishes for a more detailed explanation and suggestions for an appropriate outcome for each of the wishes in the Charter and; ways that the outcomes could be monitored. Click here to download the full Charter in more detail
References 1. (1998). The Wise and The Foolish; The paradoxical world of mental health. R.Story, St. Luke’s Art Project. 2. (2003) St Luke’s Art Project report 02 – 03 including Pool Arts Report. 3. (undated) Having A Voice Report. 4. (2005) As seen through our eyes: our vision of mental health care in Manchester. Patient and Public Involvement Forum for Manchester Mental Health. 5. (2011) A record of comments made by service users and carers in response to proposals to modernise mental health day services in Manchester. John Butler, Macc. 6. (2009) Key recommendations for the future of Primary Care Mental Health Services: a Primary Care Mental Health Service that works well for Refugees and Asylum. MARIM. 7. (2012) Notes (parts verbatim) from Manchester User Network’s Public Meeting, Friends Meeting House, Manchester, 26 June 2012. Tom Griffiths and Angela Young. 8. (2013) Specimen (Draft) Service Users Charter, Manchester Users Network. 9. Findings from a series of engagement events co-ordinated by Macc (part of the CCG’s engagement process for developing a new service specification for mental health services (2014)
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Direct Link To MACC Charter & MUN /SMUG Involvement in Charter :-
A Charter for Mental Health
Social Work Action Network Mental health services have reached a crisis point. The problems are so acute that even the government itself has been forced to acknowledge them. In response the Social Work Action Network (SWAN) has developed A Charter for Mental Health. The idea for the Charter emerged from debates at recent SWAN conferences. However it has been developed in discussion with a range of individuals and groups both within and beyond SWAN including service users and practitioners in mental health services. The Charter describes reasons for the current crisis and suggests what needs to be done to resist and build alternatives. It seeks to be a starting point for discussion and action rather than a definitive statement. SWAN invites those who support the broad perspective described here whether as an individual or on behalf of service user and community groups, campaigns, trade unions and services to endorse the Charter but also to develop further resources from it. More importantly we hope the Charter will be a useful campaigning tool for activists to help build alliances of resistance and to contribute to the development of more and better support for those with mental health needs.
1. The problems
The crisis facing service users
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.
The onslaught faced by mental health workers
Practitioners are facing ever-increasing caseloads and enormous demands to meet targets, with little organizational support to prevent isolation and burnout. These workload pressures limit the space to listen and work in person-centred ways with individuals, families and communities. Swingeing cuts to community services and in-patient facilities mean that workers are reduced to crisis intervention. This results in delays for those in need of support often with tragic consequences. It also marginalises preventative work and reduces the support available to little more than medication.
The role of the market
The introduction of payment by results is creating a ‘throughput’ approach that means short-term therapy and medical model drug interventions are prioritized over longer-term talking treatments and other forms of family and social support valued by users and carers. The growing presence of private sector providers such as Virgin Care also diverts scarce NHS resources away from frontline support and into corporate profits.
The pre-occupation with negative risk
Services are increasingly focused on risk management, monitoring of medication ‘compliance’ and controlling forms of intervention. This is particularly acute for service users from black and minority ethnic communities who have inferior access to support services and are more likely to be subject to community treatment orders or forensic interventions.
Austerity, welfare reform and inequality
While the government says mental health and wellbeing should be given the same priority as physical health care their programme is creating unprecedented levels of mental distress. Austerity and welfare reform are contributing to the rising tide of inequality, itself a cause of increasing mental health need in society. As a consequence Coalition policy is both increasing levels of mental distress and simultaneously, through cuts and the market, restricting the support available to those most in need.
2. What is to be done?
More user-led support and social approaches
Recent years have seen growing demands by service users for greater choice and control through person-centred and user-led forms of support. This is a result of campaigning and activism. Progress on this will require a greater shift towards social approaches and the creation of enabling environments. These recognize and challenge the barriers faced by those experiencing mental distress in a number of areas such as employment, housing and education. Social approaches mean the removal of obstacles to the inclusion of family, friends and community in responses to mental distress. It means support for social participation and contributing lived experience to practitioner education programmes, along with full commitment to user-led organisations, services and forms of mutual support.
Challenging all forms of discrimination including sexism, racism, homophobia and ageism as well as the demonization of welfare claimants is also crucial. This includes the stigma faced by mental health service users in society. However, while work continues to make anti-oppressive approaches, social perspectives and user and carer involvement a reality, cuts to collective services and individual support jeopardise this positive change.
Overcoming conflict and obstacles to participation
Mental health workers would like to work in more relationship-based and person-centred ways. Meanwhile service users and carers are demanding more social and community oriented support. Herein lies the potential for shared interests. But in the mental health field these may seem difficult to achieve. Historically the medical profession wielded the power to define and treat ‘mental illness’ in biomedical ways. This led to the growth of service user movements who challenged this focus and to conflict between psychiatrists and other mental health workers who rejected medical dominance.
Resources of hope: joint campaigns and struggles
Yet realization that cuts, privatisation and a target-driven culture in mental health services are negatively impacting on service users, carers and different groups of workers in similar ways is breaking down older divisions. This opens up the possibility of joint struggles. Recent campaigns against cuts have increasingly been built on alliances between service users, practitioners and their trade unions. Whilst such campaigns may start with a focus on opposing cuts, the struggle frequently raises questions about how services should be organised and run. The recent victory of a user-led campaign against mental health cuts in Salford that was supported by trade unionists ensured not only that the service was saved with decent staffing levels but also that it was more democratically and collaboratively run in partnership with service users.
More and better support
We need more alliances such as this to stop cuts and privatization and ensure people are not denied access to properly resourced community and inpatient services. However it is not enough to save services as they are, we want them to be better. This means services shaped by users with democracy and participation at the centre. Interventions based on social approaches and that challenge discrimination. Support driven by social justice rather than the profit motive. Joint campaigns by service users, carers, practitioners, trade unionists and activists have the potential not only to defend but also to transform services. SWAN invites you to join us in this struggle. The following demands are a starting point for realising these goals.
3. What we demand
- Stop the closures or reductions in community-based support and day services
- For relationship-based mental health support: achieved through increased staffing ratios, limits on the size of caseloads, less form-filling, bureaucracy and targets and more administrative support
- Increase the availability to service users of individual and group therapies, community and user-led support and reduce the emphasis on medication
- No to early withdrawal of support services from users due to ‘throughput’ care pathway models linked to payment by results
- Ensure services are staffed with properly trained practitioners and peer-support workers employed on permanent not temporary contracts
- Guarantee service user involvement in the training and continuing professional development of all mental health workers
- Develop services in line with the principles of social approaches – remove obstacles to family and community involvement; facilitate safe spaces for service users to regain confidence and skills as a basis for moving into the mainstream; support users’ social participation though volunteering and civic involvement
- Extend the availability of person-centred support to service users, no cuts to individual budgets and no increased charges for community services
- Repeal the bedroom tax and stop the evictions
- An end to welfare cuts and ’reform’; withdraw the Work Capability Assessment
- Remove multinational corporations such as ATOS from the welfare sector
- No to privatization and outsourcing of NHS, community and welfare services – for public services not private profit
- Stop the cuts of inpatient services; improve inpatient provision through a better environment, improve staff ratios; guarantee of a local placement for anyone admitted to hospital
- More funding for the development of alternatives to inpatient services such as userled crisis houses
- An end to the use of community treatment orders (CTOs)
- An end to institutionalized discrimination in mental health services: reducing disproportionate rates of admission and compulsory detention of people from black and minority ethnic (BME) communities; increase access to culturally appropriate services; improve gender sensitivity of services and safety of women on acute inpatient wards.
Link To Above SWAN Charter :-