Social exclusion: no quick fixes, warns Mind

Turning theory into practice will be difficult, says mental health charity.

Mind today welcomed the Government's action plan on social exclusion, but warned that there were many challenges ahead in its implementation.

People with mental health problems are among the most excluded members of society. Mind research shows that 84 per cent of people with mental health problems feel isolated, experiencing problems getting jobs, mortgages, healthcare, and in forming friendships or relationships. (1)

While we welcome the Government’s commitment to tackling discrimination from employers, stigma exists across the board. No progress can be made on social exclusion without a meaningful commitment to tackling the prejudice that people with mental health problems face in every aspect of their lives. England needs a fully-funded, long-term anti-stigma campaign to change hearts and minds of the kind we have seen in Scotland.

Working with people with complex needs - such as combined mental health, drugs, alcohol problems - is very challenging. We welcome the commitment to more investment in services for these most excluded people, and firmly believe that the flexibility and creativity of the voluntary sector means it is often best-placed to deliver such services. Local Mind associations have a wealth of experience in this area (see case studies below).

We welcome the Government’s intention to focus on building up the skills and confidence of people to help them find work. While we support the principles of the welfare reform agenda, one of our concerns about the Pathways to Work pilots is that people may be pushed into work before they are ready for it, triggering a relapse of their mental health problems and costing more in the long-term. Ensuring people have the necessary skills and confidence to enter the workplace is crucial.

We also welcome the commitment to look at new therapies for young people with mental health problems. We already know that talking treatments, such as Cognitive Behavioural Therapy, have a good evidence base and are recommended by the Government’s expert advisers, NICE. Yet progress on delivery has been painstakingly slow. Ninety three per cent of GPs say they have been left with no choice but to prescribe antidepressants because of the lack of availability of talking treatments in their area, with waiting lists of up to three years. (2) Having the right choice of therapies available to help people with mental health problems is crucial for their own wellbeing, and to have any hope of getting people back into work.

Paul Farmer, Chief Executive of Mind, said:
"It will be in the implementation of this plan that the real test lies. Social exclusion is the result of complex, interwoven factors in people’s lives, and there are no simple solutions to such stubborn problems.

Today’s announcement is very encouraging, but the evidence of the Government’s commitment will be in funding for the long-term. The Social Exclusion Unit produced a comprehensive report on the impact of mental ill health two years ago, which mapped out the challenges we face. But there hasn’t been the level of action on these issues that we would hope for. This is a long-term plan, but unless it is implemented quickly and effectively there is very little chance of seeing any results for many years.

We know that people with mental health problems currently on incapacity benefit are often keen to work. But it is far too often the case that, however skilled and enthusiastic they are, their hopes for work are dashed when employers refuse to take them on because of their mental health history. Survey after survey has shown that discrimination against people with a history of mental health problems is widespread in recruitment. It's positive that the Government has shown a willingness to tackle this, but discrimination exists throughout society and only in challenging that can we hope to thoroughly tackle it in recruitment. The Government must urgently fund enhanced anti-stigma programmes. Current funding levels in England for anti-stigma work fall many times below those in Scotland. Beating the discrimination which people with mental health problems face would make a very great difference to their life chances."

Case study one: Hammersmith and Fulham Mind’s assertive outreach team

Commissioned by the local PCT, this is one of very few assertive outreach teams not provided by the statutory sector. Now in its tenth year of operation, the team of 13 plus volunteers is known as Impact. They work with people with complex needs and dual mental health and drug/alcohol diagnoses, precisely the groups that the Government is hoping to target.

The team uses innovative and effective interventions to help clients recover from debilitating dependency and mental health problems that render them some of the most excluded people in society.

One client, Mark (not his real name), in his 30s, had schizophrenia and was abusing street drugs when Impact first started working with him. Over time, they stabilised his mental health situation, helped him to sort out proper accommodation, and then helped him develop life skills such as budgeting. Once Mark’s health and drug use problems improved, the team continued its commitment to him by looking at work. Mark attended day centres to improve his confidence. The team helped him go on his first holiday since childhood, to the countryside. Mark enjoyed this, and felt happier and healthier than in London, so Impact arranged for a two-month work placement on a farm in the south west of England for him. Following this, the farm offered him a job.

Team manager, Jacqui Thomas, says:

"I think we have a real advantage with clients who are often very reluctant to engage with services. We say we’re from Mind, and the door’s opened for us. If we said we were from the mental health trust, I don’t think we’d always get that far."

"Assertive outreach is certainly not a quick fix. Sometimes it will take several years of working with a client to get them back on track. But that length of time and commitment to a person is worth it for their health and wellbeing, as well as for the long-term cost benefits of keeping someone out of hospital and getting them into employment."

Case study two: Oxfordshire Mind Temple Cowley housing project

Oxfordshire Mind’s Temple Cowley housing project houses up to ten people at a time, providing intensive support to men with complex problems, including those with drug dependency, criminal convictions, and with a history of avoiding services. In an excellent demonstration of how statutory and voluntary services can work together. They work very closely with their local assertive outreach and have been very successful in improving treatment outcomes for people in their housing.

Steven (not his real name), a 30 year old African Caribbean man, was referred to Mind by the Oxford City Assertive Outreach Team. He had been in and out of psychiatric hospital several times in the few years before he was housed by Oxfordshire Mind. He had a history of drug use, offending, failed housing and a diagnosis of schizophrenia. Steven maintained his tenancy with the project for over two years. He didn’t relapse, and his drug use is minimal. Project staff helped him join the local gym, make contact with his family and start an art course. They’ve since been working with Steven to help him move on to more independent housing.

Notes

1) Mind Isolation report, 2004

2) Pulse magazine survey of GPs, 2 March 2006